| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,033 |
2,260 |
$426K |
| D0120 |
Periodic oral evaluation - established patient |
9,460 |
9,292 |
$245K |
| D1110 |
Prophylaxis - adult |
5,833 |
5,714 |
$217K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,480 |
6,521 |
$168K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,050 |
1,276 |
$164K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,142 |
7,983 |
$136K |
| D1120 |
Prophylaxis - child |
4,561 |
4,470 |
$124K |
| D0220 |
Intraoral - periapical first radiographic image |
8,467 |
8,020 |
$124K |
| D0274 |
Bitewings - four radiographic images |
3,829 |
3,729 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
827 |
540 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
2,369 |
2,221 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,927 |
1,844 |
$74K |
| D8670 |
Periodic orthodontic treatment visit |
1,225 |
1,008 |
$71K |
| D0330 |
Panoramic radiographic image |
725 |
701 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
621 |
512 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,244 |
1,217 |
$22K |
| D1351 |
Sealant - per tooth |
546 |
119 |
$13K |
| D2330 |
|
30 |
26 |
$2K |