| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,788 |
1,339 |
$199K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,334 |
1,134 |
$142K |
| D1110 |
Prophylaxis - adult |
2,345 |
2,331 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,946 |
3,924 |
$95K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,243 |
4,219 |
$88K |
| D1120 |
Prophylaxis - child |
2,552 |
2,536 |
$86K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
130 |
77 |
$66K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,248 |
1,857 |
$65K |
| D0330 |
Panoramic radiographic image |
1,228 |
1,213 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,569 |
1,560 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,691 |
1,678 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
868 |
861 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
280 |
172 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,750 |
1,689 |
$21K |
| D1351 |
Sealant - per tooth |
533 |
226 |
$15K |
| D2950 |
|
110 |
67 |
$13K |
| D1206 |
Topical application of fluoride varnish |
343 |
339 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
54 |
25 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
38 |
25 |
$3K |
| D2140 |
|
45 |
18 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
109 |
107 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
161 |
144 |
$2K |
| D2331 |
|
20 |
12 |
$2K |