| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,235 |
4,731 |
$750K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
6,739 |
3,608 |
$414K |
| D1120 |
Prophylaxis - child |
11,807 |
11,731 |
$402K |
| D0120 |
Periodic oral evaluation - established patient |
16,082 |
15,919 |
$392K |
| D1110 |
Prophylaxis - adult |
8,105 |
8,027 |
$351K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
7,763 |
7,147 |
$226K |
| D1206 |
Topical application of fluoride varnish |
10,080 |
10,007 |
$214K |
| D1208 |
Topical application of fluoride, excluding varnish |
9,481 |
9,403 |
$199K |
| D0274 |
Bitewings - four radiographic images |
5,244 |
5,182 |
$145K |
| D0330 |
Panoramic radiographic image |
3,158 |
3,124 |
$144K |
| D1351 |
Sealant - per tooth |
3,911 |
1,292 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,684 |
3,641 |
$109K |
| D0272 |
Bitewings - two radiographic images |
4,224 |
4,196 |
$77K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
482 |
388 |
$41K |
| D2394 |
|
448 |
306 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
406 |
256 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,679 |
1,657 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,966 |
992 |
$19K |
| D2330 |
|
218 |
172 |
$13K |
| D2331 |
|
91 |
80 |
$6K |
| D2332 |
|
17 |
12 |
$1K |