| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,048 |
1,627 |
$395K |
| D1120 |
Prophylaxis - child |
9,942 |
9,510 |
$310K |
| D0120 |
Periodic oral evaluation - established patient |
9,879 |
9,341 |
$247K |
| D1206 |
Topical application of fluoride varnish |
7,842 |
7,382 |
$169K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,008 |
1,250 |
$150K |
| D0272 |
Bitewings - two radiographic images |
5,624 |
5,384 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,588 |
3,191 |
$98K |
| D1110 |
Prophylaxis - adult |
2,155 |
2,006 |
$85K |
| D1351 |
Sealant - per tooth |
2,797 |
899 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,662 |
3,512 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
789 |
478 |
$60K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,591 |
1,498 |
$57K |
| D0330 |
Panoramic radiographic image |
907 |
868 |
$52K |
| D9248 |
|
328 |
300 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
467 |
431 |
$16K |
| D1310 |
|
376 |
356 |
$15K |
| D0240 |
|
1,264 |
635 |
$14K |
| D0274 |
Bitewings - four radiographic images |
222 |
205 |
$9K |
| D0425 |
|
56 |
55 |
$2K |