| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,683 |
1,131 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,157 |
874 |
$126K |
| D1110 |
Prophylaxis - adult |
2,343 |
2,302 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,980 |
3,918 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
3,188 |
3,124 |
$74K |
| D1120 |
Prophylaxis - child |
1,997 |
1,962 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,998 |
1,970 |
$52K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,698 |
1,507 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,033 |
1,018 |
$28K |
| D0330 |
Panoramic radiographic image |
467 |
457 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
259 |
121 |
$15K |
| D0272 |
Bitewings - two radiographic images |
736 |
719 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
146 |
89 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
23 |
12 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
689 |
644 |
$7K |
| D1351 |
Sealant - per tooth |
150 |
47 |
$4K |
| D9248 |
|
50 |
48 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
240 |
153 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
42 |
41 |
$888.80 |