| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,922 |
1,251 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,985 |
1,048 |
$139K |
| D0120 |
Periodic oral evaluation - established patient |
3,727 |
3,660 |
$85K |
| D1110 |
Prophylaxis - adult |
2,020 |
1,982 |
$81K |
| D1120 |
Prophylaxis - child |
2,622 |
2,580 |
$81K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,928 |
3,857 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,338 |
1,940 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
786 |
765 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,080 |
1,055 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
932 |
916 |
$25K |
| D9110 |
|
379 |
365 |
$18K |
| D0272 |
Bitewings - two radiographic images |
898 |
890 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,175 |
1,052 |
$13K |
| D1351 |
Sealant - per tooth |
481 |
134 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
110 |
63 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
224 |
218 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
85 |
54 |
$3K |
| D0330 |
Panoramic radiographic image |
67 |
66 |
$3K |
| D1206 |
Topical application of fluoride varnish |
102 |
102 |
$2K |