| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,533 |
1,204 |
$263K |
| D1120 |
Prophylaxis - child |
3,844 |
3,844 |
$134K |
| D0120 |
Periodic oral evaluation - established patient |
5,355 |
5,355 |
$123K |
| D1110 |
Prophylaxis - adult |
2,451 |
2,451 |
$123K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,213 |
6,213 |
$101K |
| D0272 |
Bitewings - two radiographic images |
5,024 |
5,024 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
6,128 |
5,906 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
929 |
533 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
830 |
470 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,388 |
5,609 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,948 |
1,765 |
$63K |
| D1351 |
Sealant - per tooth |
1,086 |
394 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
499 |
499 |
$20K |
| D0274 |
Bitewings - four radiographic images |
142 |
142 |
$4K |