| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,307 |
1,142 |
$161K |
| D9920 |
|
2,480 |
2,311 |
$160K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,835 |
872 |
$156K |
| D1120 |
Prophylaxis - child |
2,455 |
2,441 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,804 |
3,765 |
$76K |
| D1110 |
Prophylaxis - adult |
1,641 |
1,606 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
3,748 |
3,702 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
602 |
308 |
$38K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,163 |
984 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,059 |
1,045 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,316 |
1,250 |
$14K |
| D0240 |
|
862 |
584 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,028 |
374 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
240 |
225 |
$7K |
| D9994 |
|
557 |
556 |
$5K |
| D1351 |
Sealant - per tooth |
71 |
38 |
$2K |
| D0274 |
Bitewings - four radiographic images |
76 |
76 |
$2K |
| D1206 |
Topical application of fluoride varnish |
78 |
78 |
$2K |