| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,555 |
806 |
$136K |
| D1120 |
Prophylaxis - child |
2,422 |
2,405 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,935 |
2,918 |
$82K |
| D1110 |
Prophylaxis - adult |
1,297 |
1,286 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,549 |
2,531 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,187 |
1,006 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
623 |
379 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,772 |
1,755 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
588 |
579 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
58 |
$7K |
| D1206 |
Topical application of fluoride varnish |
209 |
209 |
$6K |
| D0330 |
Panoramic radiographic image |
103 |
103 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
295 |
290 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
101 |
99 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$1K |