| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,384 |
1,560 |
$165K |
| D1110 |
Prophylaxis - adult |
2,624 |
2,497 |
$132K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,098 |
822 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,479 |
3,314 |
$80K |
| D0274 |
Bitewings - four radiographic images |
2,029 |
1,921 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,218 |
855 |
$68K |
| D1120 |
Prophylaxis - child |
1,603 |
1,538 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,374 |
2,264 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,034 |
990 |
$40K |
| D1351 |
Sealant - per tooth |
1,260 |
310 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
906 |
831 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
663 |
600 |
$30K |
| D2332 |
|
102 |
77 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
923 |
824 |
$11K |
| D0272 |
Bitewings - two radiographic images |
489 |
467 |
$11K |
| D2394 |
|
86 |
64 |
$9K |
| D0330 |
Panoramic radiographic image |
152 |
146 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
101 |
80 |
$3K |
| D1206 |
Topical application of fluoride varnish |
100 |
94 |
$2K |