| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,974 |
1,046 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
6,592 |
6,429 |
$168K |
| D1110 |
Prophylaxis - adult |
3,935 |
3,839 |
$148K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,870 |
4,458 |
$91K |
| D1206 |
Topical application of fluoride varnish |
5,574 |
5,440 |
$90K |
| D0220 |
Intraoral - periapical first radiographic image |
5,670 |
5,312 |
$82K |
| D1120 |
Prophylaxis - child |
3,063 |
2,973 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,409 |
2,331 |
$72K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
665 |
448 |
$52K |
| D0330 |
Panoramic radiographic image |
917 |
865 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
662 |
618 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,047 |
998 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
421 |
393 |
$14K |
| D1351 |
Sealant - per tooth |
221 |
66 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
70 |
36 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42 |
38 |
$2K |