| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,244 |
5,523 |
$468K |
| D1206 |
Topical application of fluoride varnish |
21,948 |
21,317 |
$304K |
| D1120 |
Prophylaxis - child |
12,799 |
12,402 |
$303K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
6,569 |
5,726 |
$285K |
| D0120 |
Periodic oral evaluation - established patient |
15,562 |
15,142 |
$268K |
| D1110 |
Prophylaxis - adult |
6,007 |
5,877 |
$191K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,109 |
2,309 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,925 |
3,817 |
$86K |
| D0272 |
Bitewings - two radiographic images |
3,920 |
3,760 |
$54K |
| D1351 |
Sealant - per tooth |
2,651 |
1,026 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
757 |
740 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,871 |
1,787 |
$36K |
| D0330 |
Panoramic radiographic image |
400 |
377 |
$14K |
| D7111 |
|
233 |
174 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,121 |
1,084 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
111 |
90 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
362 |
355 |
$7K |
| D0191 |
|
384 |
339 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
65 |
62 |
$342.75 |