| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,289 |
985 |
$217K |
| D1110 |
Prophylaxis - adult |
3,093 |
3,066 |
$150K |
| D0210 |
Intraoral - complete series of radiographic images |
2,158 |
2,129 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
4,558 |
4,525 |
$129K |
| D1120 |
Prophylaxis - child |
2,847 |
2,829 |
$104K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,931 |
1,490 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
661 |
319 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,196 |
3,169 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,260 |
1,232 |
$58K |
| D0272 |
Bitewings - two radiographic images |
1,471 |
1,461 |
$33K |
| D1351 |
Sealant - per tooth |
956 |
273 |
$32K |
| D1206 |
Topical application of fluoride varnish |
830 |
828 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
135 |
65 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
205 |
191 |
$3K |