| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,139 |
1,387 |
$221K |
| D0120 |
Periodic oral evaluation - established patient |
6,719 |
6,451 |
$169K |
| D1110 |
Prophylaxis - adult |
4,718 |
4,516 |
$169K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,066 |
417 |
$116K |
| D0330 |
Panoramic radiographic image |
1,968 |
1,835 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
5,081 |
4,665 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,143 |
6,822 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
875 |
593 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,393 |
1,303 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,923 |
2,685 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,481 |
1,388 |
$44K |
| D1120 |
Prophylaxis - child |
1,195 |
1,139 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
255 |
187 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,554 |
1,478 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
791 |
745 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
222 |
202 |
$10K |
| D9239 |
|
142 |
119 |
$9K |
| D9243 |
|
34 |
24 |
$3K |
| D4346 |
|
14 |
13 |
$496.79 |
| D1206 |
Topical application of fluoride varnish |
17 |
17 |
$151.02 |