| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,655 |
1,505 |
$315K |
| D0120 |
Periodic oral evaluation - established patient |
6,156 |
6,060 |
$176K |
| D1110 |
Prophylaxis - adult |
2,905 |
2,860 |
$169K |
| D1206 |
Topical application of fluoride varnish |
6,835 |
6,734 |
$166K |
| D1120 |
Prophylaxis - child |
3,725 |
3,674 |
$157K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,113 |
738 |
$102K |
| D1351 |
Sealant - per tooth |
1,960 |
411 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,614 |
2,567 |
$56K |
| D0330 |
Panoramic radiographic image |
752 |
743 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,968 |
2,896 |
$27K |
| D1330 |
|
3,721 |
3,661 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,487 |
1,472 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,387 |
2,353 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
113 |
88 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
309 |
293 |
$13K |
| D3120 |
|
168 |
131 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
50 |
50 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
102 |
93 |
$2K |