| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,382 |
1,789 |
$310K |
| D1110 |
Prophylaxis - adult |
5,527 |
5,349 |
$280K |
| D1206 |
Topical application of fluoride varnish |
9,689 |
9,302 |
$198K |
| D0120 |
Periodic oral evaluation - established patient |
6,564 |
6,355 |
$174K |
| D1120 |
Prophylaxis - child |
4,465 |
4,300 |
$171K |
| D0140 |
Limited oral evaluation - problem focused |
2,879 |
2,734 |
$117K |
| D0274 |
Bitewings - four radiographic images |
2,974 |
2,893 |
$96K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
952 |
716 |
$84K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,429 |
1,336 |
$62K |
| D0330 |
Panoramic radiographic image |
719 |
702 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
532 |
314 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,365 |
2,246 |
$44K |
| D0272 |
Bitewings - two radiographic images |
636 |
596 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
121 |
119 |
$8K |
| D1351 |
Sealant - per tooth |
206 |
65 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
60 |
58 |
$3K |
| D4346 |
|
30 |
30 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
85 |
50 |
$1K |
| D0603 |
|
1,121 |
1,075 |
$0.00 |
| D0602 |
|
843 |
807 |
$0.00 |
| D0601 |
|
1,379 |
1,306 |
$0.00 |