| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,026 |
2,464 |
$401K |
| D0350 |
|
19,428 |
8,694 |
$344K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,237 |
2,321 |
$278K |
| D1110 |
Prophylaxis - adult |
6,737 |
6,646 |
$225K |
| D0240 |
|
11,542 |
7,267 |
$171K |
| D0274 |
Bitewings - four radiographic images |
7,101 |
7,010 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
7,795 |
7,705 |
$130K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,435 |
995 |
$127K |
| D1354 |
|
6,314 |
1,648 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,301 |
3,246 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
2,068 |
2,063 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,038 |
755 |
$67K |
| D1120 |
Prophylaxis - child |
3,164 |
3,135 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,690 |
3,634 |
$54K |
| D0330 |
Panoramic radiographic image |
976 |
958 |
$44K |
| D2160 |
|
692 |
413 |
$43K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,661 |
1,563 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
6,242 |
6,139 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,519 |
5,433 |
$27K |
| D0272 |
Bitewings - two radiographic images |
2,534 |
2,511 |
$25K |
| D1320 |
|
1,689 |
1,673 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,404 |
1,399 |
$21K |
| D2140 |
|
402 |
158 |
$16K |
| D1351 |
Sealant - per tooth |
688 |
166 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
313 |
294 |
$7K |
| D1321 |
|
19 |
19 |
$285.00 |