| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,936 |
1,948 |
$346K |
| D1120 |
Prophylaxis - child |
7,297 |
6,000 |
$180K |
| D0120 |
Periodic oral evaluation - established patient |
4,610 |
4,294 |
$122K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,745 |
6,345 |
$107K |
| D0140 |
Limited oral evaluation - problem focused |
3,203 |
2,270 |
$89K |
| D0330 |
Panoramic radiographic image |
1,845 |
1,533 |
$83K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
675 |
380 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
987 |
654 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,676 |
1,682 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,814 |
1,540 |
$48K |
| D1351 |
Sealant - per tooth |
1,133 |
261 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,330 |
1,024 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
995 |
566 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
295 |
131 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
488 |
423 |
$6K |
| D1110 |
Prophylaxis - adult |
47 |
14 |
$0.00 |
| D1999 |
|
44 |
38 |
$0.00 |