| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,178 |
2,594 |
$441K |
| D0120 |
Periodic oral evaluation - established patient |
17,062 |
16,290 |
$437K |
| D1120 |
Prophylaxis - child |
13,892 |
13,209 |
$372K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,343 |
18,451 |
$318K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,762 |
2,872 |
$293K |
| D1351 |
Sealant - per tooth |
10,237 |
2,282 |
$283K |
| D1110 |
Prophylaxis - adult |
6,075 |
5,858 |
$231K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,145 |
1,866 |
$199K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,737 |
2,611 |
$121K |
| D0330 |
Panoramic radiographic image |
2,044 |
1,942 |
$116K |
| D0272 |
Bitewings - two radiographic images |
6,180 |
5,868 |
$112K |
| D0274 |
Bitewings - four radiographic images |
3,266 |
3,145 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
1,661 |
1,554 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
3,292 |
3,052 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
293 |
252 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,801 |
1,333 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
422 |
340 |
$16K |
| D2330 |
|
94 |
69 |
$6K |
| D7111 |
|
45 |
29 |
$2K |
| D9986 |
|
52 |
26 |
$0.00 |