| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
3,360 |
3,125 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,462 |
783 |
$78K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
936 |
546 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,678 |
3,361 |
$59K |
| D1120 |
Prophylaxis - child |
2,473 |
2,263 |
$50K |
| D1110 |
Prophylaxis - adult |
954 |
887 |
$34K |
| D0272 |
Bitewings - two radiographic images |
2,719 |
2,496 |
$25K |
| D2140 |
|
472 |
238 |
$22K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
215 |
119 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
447 |
386 |
$3K |
| D0274 |
Bitewings - four radiographic images |
163 |
150 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
28 |
25 |
$874.70 |
| D9999 |
Unspecified adjunctive procedure, by report |
47 |
36 |
$524.00 |