| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,966 |
1,069 |
$195K |
| D1120 |
Prophylaxis - child |
2,855 |
2,787 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
517 |
312 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
3,195 |
3,119 |
$63K |
| D1206 |
Topical application of fluoride varnish |
3,948 |
3,855 |
$63K |
| D1110 |
Prophylaxis - adult |
1,320 |
1,303 |
$54K |
| D0330 |
Panoramic radiographic image |
1,028 |
1,020 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,185 |
3,078 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,518 |
1,326 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,322 |
1,303 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,164 |
1,112 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,074 |
1,058 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,905 |
1,687 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
404 |
258 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
142 |
41 |
$17K |
| D0272 |
Bitewings - two radiographic images |
795 |
790 |
$14K |
| D1320 |
|
431 |
425 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
41 |
$6K |
| D0350 |
|
197 |
197 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
314 |
314 |
$4K |
| D1351 |
Sealant - per tooth |
156 |
45 |
$4K |