| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,965 |
1,758 |
$361K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,242 |
1,330 |
$222K |
| D1110 |
Prophylaxis - adult |
3,580 |
3,525 |
$176K |
| D0120 |
Periodic oral evaluation - established patient |
5,256 |
5,168 |
$150K |
| D0330 |
Panoramic radiographic image |
2,785 |
2,748 |
$133K |
| D1120 |
Prophylaxis - child |
3,309 |
3,260 |
$121K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,029 |
2,446 |
$109K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,344 |
4,277 |
$89K |
| D0272 |
Bitewings - two radiographic images |
5,858 |
5,557 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,139 |
1,115 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
869 |
867 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,162 |
2,134 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,982 |
2,791 |
$27K |
| D1351 |
Sealant - per tooth |
860 |
313 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
217 |
130 |
$24K |
| D1206 |
Topical application of fluoride varnish |
767 |
756 |
$21K |