| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,033 |
2,460 |
$432K |
| D0120 |
Periodic oral evaluation - established patient |
10,493 |
10,319 |
$268K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,007 |
1,900 |
$244K |
| D1110 |
Prophylaxis - adult |
5,541 |
5,458 |
$214K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,600 |
9,448 |
$128K |
| D1120 |
Prophylaxis - child |
4,576 |
4,527 |
$128K |
| D0330 |
Panoramic radiographic image |
2,067 |
2,018 |
$101K |
| D0274 |
Bitewings - four radiographic images |
2,559 |
2,507 |
$80K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,427 |
1,317 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,378 |
1,347 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
4,033 |
3,886 |
$60K |
| D7140 |
Extraction, erupted tooth or exposed root |
857 |
267 |
$55K |
| D0272 |
Bitewings - two radiographic images |
2,676 |
2,637 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
253 |
198 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
339 |
211 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,371 |
1,695 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
378 |
365 |
$13K |
| D1206 |
Topical application of fluoride varnish |
719 |
713 |
$10K |
| D9243 |
|
41 |
25 |
$3K |
| D2140 |
|
44 |
29 |
$3K |
| D1351 |
Sealant - per tooth |
84 |
27 |
$2K |
| D9239 |
|
25 |
25 |
$2K |
| D4346 |
|
45 |
45 |
$2K |
| D2330 |
|
20 |
13 |
$1K |