| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
582 |
225 |
$58K |
| D1120 |
Prophylaxis - child |
1,216 |
1,179 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,268 |
3,044 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,533 |
1,481 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,957 |
1,845 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,177 |
1,096 |
$38K |
| D2394 |
|
360 |
132 |
$38K |
| D0330 |
Panoramic radiographic image |
945 |
846 |
$37K |
| D1351 |
Sealant - per tooth |
1,282 |
199 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,527 |
2,682 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,189 |
1,107 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
226 |
102 |
$21K |
| D1110 |
Prophylaxis - adult |
477 |
450 |
$20K |
| D0272 |
Bitewings - two radiographic images |
723 |
684 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
190 |
91 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
432 |
401 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
14 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
206 |
169 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
149 |
124 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
31 |
31 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
182 |
182 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
27 |
12 |
$3K |
| D1330 |
|
50 |
50 |
$0.00 |
| D1310 |
|
13 |
13 |
$0.00 |
| D1999 |
|
348 |
299 |
$0.00 |