| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,553 |
4,767 |
$972K |
| D0120 |
Periodic oral evaluation - established patient |
23,909 |
23,731 |
$690K |
| D1120 |
Prophylaxis - child |
17,262 |
17,122 |
$631K |
| D1110 |
Prophylaxis - adult |
12,318 |
12,215 |
$621K |
| D1208 |
Topical application of fluoride, excluding varnish |
15,992 |
15,891 |
$334K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,363 |
1,460 |
$303K |
| D0272 |
Bitewings - two radiographic images |
13,710 |
13,605 |
$288K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,123 |
2,659 |
$285K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,550 |
3,514 |
$174K |
| D1206 |
Topical application of fluoride varnish |
4,528 |
4,492 |
$116K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,908 |
1,889 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
5,073 |
4,836 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,875 |
2,065 |
$54K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
564 |
442 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
1,475 |
1,450 |
$21K |
| D0330 |
Panoramic radiographic image |
253 |
250 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
195 |
194 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
48 |
19 |
$4K |
| D2160 |
|
30 |
15 |
$3K |
| D2332 |
|
18 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
59 |
17 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
15 |
$2K |
| D7111 |
|
17 |
12 |
$1K |