| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,569 |
1,829 |
$381K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,235 |
1,775 |
$338K |
| D0120 |
Periodic oral evaluation - established patient |
4,259 |
4,083 |
$109K |
| D1120 |
Prophylaxis - child |
3,412 |
3,290 |
$92K |
| D1351 |
Sealant - per tooth |
3,128 |
909 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,624 |
3,469 |
$59K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
441 |
320 |
$58K |
| D1110 |
Prophylaxis - adult |
1,466 |
1,396 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
2,893 |
2,708 |
$43K |
| D0330 |
Panoramic radiographic image |
671 |
637 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
755 |
594 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,744 |
2,327 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,003 |
948 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
697 |
663 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,530 |
1,473 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
428 |
262 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
534 |
504 |
$19K |
| D1206 |
Topical application of fluoride varnish |
885 |
853 |
$14K |
| D0240 |
|
316 |
303 |
$10K |
| D2330 |
|
104 |
66 |
$6K |