| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,844 |
829 |
$244K |
| D1120 |
Prophylaxis - child |
2,496 |
2,469 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,833 |
1,807 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
782 |
394 |
$80K |
| D0120 |
Periodic oral evaluation - established patient |
2,206 |
2,179 |
$67K |
| D9248 |
|
341 |
326 |
$64K |
| D1110 |
Prophylaxis - adult |
987 |
973 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
3,407 |
3,334 |
$35K |
| D0330 |
Panoramic radiographic image |
754 |
734 |
$33K |
| D1351 |
Sealant - per tooth |
724 |
126 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,463 |
1,440 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
345 |
345 |
$20K |
| D0274 |
Bitewings - four radiographic images |
824 |
807 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,877 |
2,831 |
$19K |
| D1206 |
Topical application of fluoride varnish |
602 |
602 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
60 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
265 |
261 |
$12K |
| D1330 |
|
1,139 |
1,125 |
$7K |
| D3120 |
|
192 |
73 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
302 |
268 |
$5K |