| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,362 |
1,295 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
5,752 |
5,744 |
$159K |
| D1120 |
Prophylaxis - child |
3,837 |
3,834 |
$151K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,684 |
5,676 |
$106K |
| D1110 |
Prophylaxis - adult |
1,915 |
1,910 |
$89K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,357 |
640 |
$86K |
| D0272 |
Bitewings - two radiographic images |
1,559 |
1,557 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,059 |
1,058 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,956 |
1,923 |
$25K |
| D1351 |
Sealant - per tooth |
734 |
337 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
641 |
560 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,740 |
1,531 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
125 |
79 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
213 |
213 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
221 |
218 |
$8K |
| D0603 |
|
350 |
346 |
$4K |
| D1999 |
|
313 |
278 |
$2K |
| D0240 |
|
129 |
65 |
$2K |
| D9920 |
|
27 |
25 |
$1K |
| D1330 |
|
80 |
80 |
$720.00 |
| D1320 |
|
18 |
18 |
$170.00 |