| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,171 |
612 |
$152K |
| D1120 |
Prophylaxis - child |
3,053 |
3,026 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,290 |
3,264 |
$81K |
| D1110 |
Prophylaxis - adult |
971 |
962 |
$48K |
| D1206 |
Topical application of fluoride varnish |
1,467 |
1,442 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
989 |
925 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
725 |
718 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,289 |
2,275 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,267 |
1,254 |
$26K |
| D0240 |
|
343 |
343 |
$13K |
| D1351 |
Sealant - per tooth |
366 |
96 |
$12K |
| D0274 |
Bitewings - four radiographic images |
357 |
355 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
53 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
368 |
354 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
140 |
135 |
$5K |
| D0330 |
Panoramic radiographic image |
81 |
81 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
12 |
$2K |