| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,703 |
2,786 |
$430K |
| D1120 |
Prophylaxis - child |
9,038 |
8,725 |
$274K |
| D0120 |
Periodic oral evaluation - established patient |
11,185 |
10,796 |
$233K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,975 |
10,575 |
$172K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,043 |
5,516 |
$162K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,862 |
1,198 |
$136K |
| D0274 |
Bitewings - four radiographic images |
4,588 |
4,497 |
$128K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,805 |
868 |
$118K |
| D1110 |
Prophylaxis - adult |
2,032 |
1,979 |
$88K |
| D0330 |
Panoramic radiographic image |
1,504 |
1,470 |
$86K |
| D0272 |
Bitewings - two radiographic images |
3,138 |
3,055 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
394 |
327 |
$47K |
| D1351 |
Sealant - per tooth |
524 |
198 |
$12K |
| D1206 |
Topical application of fluoride varnish |
386 |
372 |
$11K |
| D0240 |
|
339 |
194 |
$6K |
| D1999 |
|
1,536 |
1,381 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
183 |
174 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
49 |
$2K |