| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,841 |
2,033 |
$398K |
| D0120 |
Periodic oral evaluation - established patient |
9,784 |
9,625 |
$203K |
| D1110 |
Prophylaxis - adult |
4,266 |
4,186 |
$189K |
| D1120 |
Prophylaxis - child |
6,100 |
6,010 |
$181K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,672 |
1,603 |
$155K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,150 |
9,988 |
$150K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,098 |
3,622 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
5,779 |
5,652 |
$86K |
| D0330 |
Panoramic radiographic image |
1,696 |
1,680 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,236 |
2,199 |
$66K |
| D0272 |
Bitewings - two radiographic images |
3,162 |
3,126 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,020 |
4,828 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
466 |
233 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
122 |
81 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
496 |
464 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
435 |
421 |
$13K |
| D1351 |
Sealant - per tooth |
238 |
66 |
$6K |