| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,466 |
2,100 |
$589K |
| D0120 |
Periodic oral evaluation - established patient |
19,349 |
19,026 |
$510K |
| D1120 |
Prophylaxis - child |
13,443 |
13,231 |
$375K |
| D1208 |
Topical application of fluoride, excluding varnish |
19,848 |
19,508 |
$334K |
| D1110 |
Prophylaxis - adult |
6,691 |
6,559 |
$260K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,860 |
1,719 |
$233K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,861 |
4,265 |
$215K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,928 |
1,355 |
$189K |
| D0272 |
Bitewings - two radiographic images |
6,312 |
6,200 |
$114K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,746 |
1,703 |
$79K |
| D0170 |
|
1,747 |
1,686 |
$52K |
| D0140 |
Limited oral evaluation - problem focused |
1,359 |
1,300 |
$51K |
| D9420 |
|
402 |
392 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,868 |
2,773 |
$44K |
| D1351 |
Sealant - per tooth |
1,412 |
406 |
$38K |
| D2330 |
|
414 |
246 |
$29K |
| D1354 |
|
1,265 |
559 |
$10K |
| D0330 |
Panoramic radiographic image |
163 |
151 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
14 |
$4K |
| D2331 |
|
15 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
38 |
$726.55 |