| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,346 |
2,336 |
$414K |
| D0120 |
Periodic oral evaluation - established patient |
9,195 |
9,053 |
$257K |
| D1110 |
Prophylaxis - adult |
4,638 |
4,566 |
$227K |
| D1120 |
Prophylaxis - child |
6,077 |
5,993 |
$218K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,204 |
1,321 |
$155K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,861 |
6,770 |
$140K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,445 |
2,898 |
$124K |
| D0272 |
Bitewings - two radiographic images |
5,032 |
4,965 |
$110K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
917 |
596 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,144 |
1,117 |
$54K |
| D1206 |
Topical application of fluoride varnish |
1,236 |
1,215 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
962 |
917 |
$13K |
| D0330 |
Panoramic radiographic image |
127 |
121 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
176 |
$2K |
| D1351 |
Sealant - per tooth |
36 |
12 |
$1K |