| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,442 |
3,266 |
$659K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,837 |
2,212 |
$426K |
| D1110 |
Prophylaxis - adult |
5,659 |
5,622 |
$286K |
| D0120 |
Periodic oral evaluation - established patient |
9,699 |
9,644 |
$275K |
| D1120 |
Prophylaxis - child |
5,354 |
5,333 |
$182K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,426 |
8,379 |
$175K |
| D0210 |
Intraoral - complete series of radiographic images |
1,810 |
1,804 |
$116K |
| D0272 |
Bitewings - two radiographic images |
4,866 |
4,829 |
$104K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,384 |
770 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,062 |
1,035 |
$51K |
| D1351 |
Sealant - per tooth |
1,004 |
434 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
739 |
697 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,314 |
1,297 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
78 |
57 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
706 |
226 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
77 |
77 |
$990.00 |