| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,210 |
2,224 |
$337K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,674 |
1,967 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
8,127 |
8,035 |
$212K |
| D1120 |
Prophylaxis - child |
6,358 |
6,264 |
$173K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,836 |
7,737 |
$130K |
| D1110 |
Prophylaxis - adult |
2,531 |
2,501 |
$98K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,249 |
1,910 |
$97K |
| D1351 |
Sealant - per tooth |
2,017 |
729 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,487 |
2,447 |
$46K |
| D0274 |
Bitewings - four radiographic images |
1,035 |
1,029 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
349 |
224 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
415 |
398 |
$18K |
| D1206 |
Topical application of fluoride varnish |
638 |
619 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
526 |
518 |
$8K |
| D0330 |
Panoramic radiographic image |
117 |
116 |
$6K |
| D0240 |
|
237 |
137 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
78 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
19 |
17 |
$3K |