| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,514 |
1,893 |
$552K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,534 |
643 |
$190K |
| D0120 |
Periodic oral evaluation - established patient |
5,467 |
5,233 |
$152K |
| D1110 |
Prophylaxis - adult |
3,050 |
2,891 |
$148K |
| D1120 |
Prophylaxis - child |
4,025 |
3,849 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,255 |
704 |
$88K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,126 |
3,913 |
$81K |
| D0272 |
Bitewings - two radiographic images |
3,125 |
2,989 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,076 |
1,013 |
$51K |
| D1206 |
Topical application of fluoride varnish |
1,796 |
1,720 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
469 |
458 |
$36K |
| D1351 |
Sealant - per tooth |
610 |
202 |
$19K |
| D0330 |
Panoramic radiographic image |
153 |
130 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
249 |
210 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
504 |
440 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
166 |
150 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
32 |
25 |
$1K |