| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,850 |
1,008 |
$249K |
| D1120 |
Prophylaxis - child |
7,746 |
7,668 |
$248K |
| D0120 |
Periodic oral evaluation - established patient |
9,487 |
9,442 |
$222K |
| D1206 |
Topical application of fluoride varnish |
10,811 |
10,575 |
$199K |
| D1110 |
Prophylaxis - adult |
3,322 |
3,291 |
$145K |
| D0272 |
Bitewings - two radiographic images |
5,150 |
5,112 |
$107K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,022 |
2,923 |
$94K |
| D1351 |
Sealant - per tooth |
1,703 |
566 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
418 |
259 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
843 |
834 |
$33K |
| D0330 |
Panoramic radiographic image |
505 |
505 |
$25K |
| D0274 |
Bitewings - four radiographic images |
436 |
431 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
669 |
669 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
491 |
484 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
25 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$426.53 |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
14 |
$392.17 |