| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,180 |
992 |
$220K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
849 |
497 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,026 |
611 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,508 |
2,425 |
$61K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,333 |
1,202 |
$54K |
| D1110 |
Prophylaxis - adult |
1,468 |
1,455 |
$53K |
| D1120 |
Prophylaxis - child |
1,799 |
1,758 |
$47K |
| D0330 |
Panoramic radiographic image |
850 |
832 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,078 |
1,046 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,649 |
2,540 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,430 |
2,276 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,855 |
2,010 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,050 |
1,030 |
$31K |
| D4355 |
|
347 |
339 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
430 |
419 |
$15K |
| D0272 |
Bitewings - two radiographic images |
712 |
700 |
$13K |
| D1351 |
Sealant - per tooth |
384 |
71 |
$10K |
| D7111 |
|
138 |
76 |
$7K |
| D2394 |
|
39 |
27 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
13 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
37 |
37 |
$1K |
| D2331 |
|
17 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
37 |
37 |
$602.50 |