| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
927 |
531 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
2,290 |
2,249 |
$55K |
| D1120 |
Prophylaxis - child |
1,726 |
1,696 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,063 |
932 |
$43K |
| D1110 |
Prophylaxis - adult |
928 |
909 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,904 |
1,874 |
$30K |
| D1351 |
Sealant - per tooth |
1,079 |
369 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
312 |
231 |
$23K |
| D0330 |
Panoramic radiographic image |
400 |
390 |
$20K |
| D0272 |
Bitewings - two radiographic images |
775 |
760 |
$13K |
| D0274 |
Bitewings - four radiographic images |
424 |
414 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
212 |
139 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
268 |
262 |
$11K |
| D1206 |
Topical application of fluoride varnish |
670 |
654 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
237 |
229 |
$8K |
| D0240 |
|
210 |
122 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
192 |
182 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
14 |
$2K |