| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,886 |
755 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
1,642 |
1,633 |
$111K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,492 |
683 |
$98K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,401 |
1,392 |
$89K |
| D1120 |
Prophylaxis - child |
2,017 |
2,004 |
$87K |
| D0350 |
|
7,006 |
1,428 |
$73K |
| D2394 |
|
654 |
275 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
979 |
972 |
$45K |
| D1206 |
Topical application of fluoride varnish |
2,704 |
2,689 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,603 |
1,963 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
928 |
625 |
$36K |
| D4910 |
|
356 |
356 |
$26K |
| D0274 |
Bitewings - four radiographic images |
986 |
984 |
$21K |
| D9430 |
|
549 |
503 |
$17K |
| D1110 |
Prophylaxis - adult |
97 |
95 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
147 |
77 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
99 |
50 |
$5K |
| D0272 |
Bitewings - two radiographic images |
351 |
346 |
$4K |
| D4341 |
|
44 |
12 |
$3K |
| D1320 |
|
208 |
208 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
119 |
111 |
$1K |
| D0330 |
Panoramic radiographic image |
45 |
45 |
$1K |