| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,879 |
1,601 |
$224K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,358 |
1,349 |
$221K |
| D1120 |
Prophylaxis - child |
5,927 |
5,862 |
$141K |
| D1206 |
Topical application of fluoride varnish |
8,685 |
8,580 |
$127K |
| D1110 |
Prophylaxis - adult |
3,168 |
3,115 |
$103K |
| D0330 |
Panoramic radiographic image |
2,624 |
2,457 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,989 |
3,618 |
$92K |
| D0120 |
Periodic oral evaluation - established patient |
5,571 |
5,514 |
$74K |
| D1351 |
Sealant - per tooth |
2,797 |
885 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
2,650 |
2,523 |
$47K |
| D0274 |
Bitewings - four radiographic images |
2,242 |
2,214 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,686 |
3,193 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
854 |
719 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
3,805 |
3,425 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,446 |
1,196 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
132 |
44 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
57 |
26 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$2K |