| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,636 |
1,858 |
$324K |
| D1206 |
Topical application of fluoride varnish |
10,089 |
9,690 |
$244K |
| D1351 |
Sealant - per tooth |
6,809 |
1,467 |
$224K |
| D1120 |
Prophylaxis - child |
5,321 |
5,081 |
$223K |
| D0120 |
Periodic oral evaluation - established patient |
6,500 |
6,296 |
$189K |
| D1110 |
Prophylaxis - adult |
2,531 |
2,431 |
$150K |
| D0274 |
Bitewings - four radiographic images |
4,491 |
4,305 |
$99K |
| D0330 |
Panoramic radiographic image |
1,581 |
1,538 |
$67K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
311 |
253 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,501 |
2,395 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
349 |
284 |
$34K |
| D1330 |
|
4,712 |
4,546 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
513 |
493 |
$26K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,341 |
1,224 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
273 |
251 |
$11K |
| D3120 |
|
61 |
53 |
$2K |
| D2940 |
|
30 |
24 |
$2K |
| D0240 |
|
104 |
81 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
123 |
115 |
$1K |