| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,272 |
1,878 |
$341K |
| D1120 |
Prophylaxis - child |
6,567 |
6,432 |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
6,087 |
5,953 |
$196K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,433 |
6,304 |
$172K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,176 |
819 |
$156K |
| D0330 |
Panoramic radiographic image |
1,364 |
1,320 |
$103K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,579 |
1,459 |
$89K |
| D0140 |
Limited oral evaluation - problem focused |
1,210 |
1,152 |
$54K |
| D1351 |
Sealant - per tooth |
1,305 |
420 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,059 |
1,032 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,443 |
1,409 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
604 |
594 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
370 |
279 |
$31K |
| D7140 |
Extraction, erupted tooth or exposed root |
283 |
151 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
282 |
272 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
203 |
115 |
$3K |
| D1206 |
Topical application of fluoride varnish |
38 |
38 |
$1K |