| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,192 |
537 |
$56K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
602 |
331 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,338 |
1,231 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
905 |
854 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
950 |
911 |
$17K |
| D1110 |
Prophylaxis - adult |
501 |
477 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,761 |
1,625 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
292 |
161 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
785 |
740 |
$10K |
| D1351 |
Sealant - per tooth |
447 |
87 |
$8K |
| D9110 |
|
115 |
107 |
$5K |
| D0274 |
Bitewings - four radiographic images |
484 |
468 |
$5K |
| D2331 |
|
93 |
37 |
$4K |
| D1120 |
Prophylaxis - child |
236 |
198 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
215 |
204 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,785 |
1,003 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
70 |
58 |
$1K |
| D1206 |
Topical application of fluoride varnish |
52 |
37 |
$589.99 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$133.77 |