| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,165 |
468 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
2,717 |
2,493 |
$67K |
| D1110 |
Prophylaxis - adult |
1,681 |
1,548 |
$61K |
| D1120 |
Prophylaxis - child |
1,550 |
1,326 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,120 |
941 |
$29K |
| D0330 |
Panoramic radiographic image |
501 |
414 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,192 |
1,164 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
552 |
448 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,302 |
1,099 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
548 |
425 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
700 |
318 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,180 |
977 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
300 |
123 |
$14K |
| D0272 |
Bitewings - two radiographic images |
625 |
531 |
$10K |
| D1351 |
Sealant - per tooth |
516 |
99 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
775 |
584 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
269 |
66 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
26 |
$4K |