| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,397 |
601 |
$128K |
| D1110 |
Prophylaxis - adult |
2,675 |
2,326 |
$88K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,340 |
2,625 |
$82K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,585 |
1,293 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,666 |
1,387 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,417 |
2,149 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,999 |
1,704 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,316 |
2,789 |
$42K |
| D0330 |
Panoramic radiographic image |
820 |
681 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,203 |
963 |
$35K |
| D4355 |
|
538 |
453 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,896 |
1,684 |
$28K |
| D2394 |
|
243 |
95 |
$25K |
| D1120 |
Prophylaxis - child |
876 |
774 |
$22K |
| D0160 |
|
358 |
286 |
$19K |
| D0240 |
|
934 |
430 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
192 |
94 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
84 |
51 |
$9K |
| D9110 |
|
255 |
186 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
18 |
$4K |
| D1351 |
Sealant - per tooth |
123 |
24 |
$3K |
| D0272 |
Bitewings - two radiographic images |
156 |
141 |
$2K |
| D1330 |
|
14 |
14 |
$0.00 |