| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,420 |
1,383 |
$192K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,302 |
2,354 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
2,393 |
2,286 |
$58K |
| D1120 |
Prophylaxis - child |
1,840 |
1,806 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
964 |
620 |
$54K |
| D1110 |
Prophylaxis - adult |
1,214 |
1,190 |
$52K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
534 |
342 |
$51K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,711 |
1,679 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,497 |
1,470 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
313 |
283 |
$12K |
| D1206 |
Topical application of fluoride varnish |
492 |
478 |
$11K |
| D0330 |
Panoramic radiographic image |
122 |
114 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
261 |
252 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
16 |
12 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
107 |
104 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
13 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$722.04 |