| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,747 |
1,552 |
$202K |
| D1110 |
Prophylaxis - adult |
3,684 |
3,406 |
$171K |
| D0120 |
Periodic oral evaluation - established patient |
5,351 |
4,929 |
$115K |
| D0330 |
Panoramic radiographic image |
1,814 |
1,652 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,206 |
2,870 |
$96K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
892 |
584 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,314 |
869 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,160 |
1,951 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,752 |
3,453 |
$73K |
| D1120 |
Prophylaxis - child |
1,979 |
1,849 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,177 |
2,722 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,365 |
3,000 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
816 |
725 |
$30K |
| D1351 |
Sealant - per tooth |
983 |
199 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
1,298 |
1,138 |
$28K |
| D4910 |
|
53 |
51 |
$6K |
| D2394 |
|
30 |
25 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
100 |
82 |
$3K |
| D2332 |
|
20 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
14 |
14 |
$370.72 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$298.53 |