| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,875 |
1,145 |
$183K |
| D0120 |
Periodic oral evaluation - established patient |
7,749 |
6,735 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,910 |
3,679 |
$158K |
| D1120 |
Prophylaxis - child |
5,845 |
5,151 |
$142K |
| D1206 |
Topical application of fluoride varnish |
9,447 |
8,272 |
$136K |
| D0330 |
Panoramic radiographic image |
2,715 |
2,518 |
$133K |
| D1110 |
Prophylaxis - adult |
3,486 |
3,192 |
$121K |
| D0220 |
Intraoral - periapical first radiographic image |
7,071 |
6,299 |
$98K |
| D0274 |
Bitewings - four radiographic images |
3,137 |
2,892 |
$90K |
| D1351 |
Sealant - per tooth |
2,900 |
730 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,126 |
5,112 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
764 |
526 |
$57K |
| D0272 |
Bitewings - two radiographic images |
2,382 |
2,065 |
$39K |
| 99199 |
Unlisted special service, procedure or report |
8,495 |
8,476 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
799 |
710 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
171 |
132 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
292 |
121 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
190 |
175 |
$9K |
| D4355 |
|
56 |
55 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
48 |
42 |
$3K |
| D9995 |
|
12 |
12 |
$752.27 |