| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,756 |
710 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
4,490 |
4,089 |
$75K |
| D1120 |
Prophylaxis - child |
2,945 |
2,715 |
$72K |
| D1999 |
|
3,912 |
3,258 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,710 |
4,303 |
$61K |
| D1110 |
Prophylaxis - adult |
1,793 |
1,619 |
$57K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
956 |
464 |
$52K |
| D0240 |
|
2,649 |
1,202 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,929 |
1,570 |
$34K |
| D0330 |
Panoramic radiographic image |
570 |
526 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,186 |
1,098 |
$19K |
| D0274 |
Bitewings - four radiographic images |
772 |
705 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
497 |
452 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
148 |
69 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
305 |
248 |
$7K |
| D1206 |
Topical application of fluoride varnish |
330 |
282 |
$7K |
| D1351 |
Sealant - per tooth |
136 |
33 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
184 |
141 |
$1K |
| D2950 |
|
24 |
13 |
$1K |