| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
900 |
608 |
$136K |
| D1120 |
Prophylaxis - child |
1,958 |
1,891 |
$91K |
| D1206 |
Topical application of fluoride varnish |
2,728 |
2,626 |
$80K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
646 |
446 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,206 |
2,123 |
$71K |
| D1110 |
Prophylaxis - adult |
903 |
865 |
$65K |
| D0330 |
Panoramic radiographic image |
640 |
621 |
$59K |
| D1351 |
Sealant - per tooth |
1,449 |
511 |
$56K |
| D0272 |
Bitewings - two radiographic images |
1,284 |
1,245 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
364 |
243 |
$41K |
| D0274 |
Bitewings - four radiographic images |
786 |
758 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
560 |
539 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
418 |
359 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
242 |
240 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
701 |
687 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
102 |
101 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
22 |
14 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
65 |
$2K |