| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,391 |
780 |
$91K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,633 |
979 |
$89K |
| D1110 |
Prophylaxis - adult |
1,958 |
1,933 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,623 |
1,613 |
$34K |
| D1351 |
Sealant - per tooth |
1,295 |
434 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
2,343 |
2,318 |
$31K |
| D0330 |
Panoramic radiographic image |
523 |
518 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,691 |
1,618 |
$20K |
| D0274 |
Bitewings - four radiographic images |
693 |
682 |
$18K |
| D1120 |
Prophylaxis - child |
827 |
821 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,865 |
1,821 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
388 |
383 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
383 |
331 |
$9K |
| D3120 |
|
604 |
340 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
572 |
560 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
122 |
$3K |
| D1206 |
Topical application of fluoride varnish |
983 |
968 |
$3K |
| D0272 |
Bitewings - two radiographic images |
122 |
122 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
13 |
$0.00 |