| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,922 |
2,385 |
$381K |
| D1120 |
Prophylaxis - child |
8,419 |
8,329 |
$235K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,345 |
11,219 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
9,548 |
9,436 |
$155K |
| D1110 |
Prophylaxis - adult |
4,085 |
4,042 |
$148K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,823 |
932 |
$127K |
| D9920 |
|
1,539 |
1,486 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,196 |
3,169 |
$86K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,951 |
2,705 |
$81K |
| D1351 |
Sealant - per tooth |
2,689 |
945 |
$70K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
145 |
135 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,744 |
2,705 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,800 |
2,772 |
$46K |
| D2740 |
Crown - porcelain/ceramic |
96 |
82 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
369 |
247 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,634 |
2,548 |
$22K |
| D2950 |
|
160 |
130 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
680 |
666 |
$11K |
| D0330 |
Panoramic radiographic image |
127 |
127 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
110 |
77 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
441 |
282 |
$3K |