| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,233 |
3,568 |
$391K |
| D1110 |
Prophylaxis - adult |
7,347 |
6,808 |
$329K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,074 |
1,472 |
$238K |
| D0120 |
Periodic oral evaluation - established patient |
9,767 |
9,102 |
$202K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,714 |
2,400 |
$179K |
| D0274 |
Bitewings - four radiographic images |
4,356 |
4,037 |
$140K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,703 |
1,181 |
$137K |
| D1120 |
Prophylaxis - child |
4,486 |
4,198 |
$129K |
| D0330 |
Panoramic radiographic image |
1,904 |
1,734 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,586 |
5,267 |
$100K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,038 |
3,364 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,467 |
2,273 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
1,952 |
1,775 |
$69K |
| D2331 |
|
664 |
432 |
$60K |
| D0272 |
Bitewings - two radiographic images |
2,307 |
2,145 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
4,210 |
3,793 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,889 |
1,707 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,579 |
1,868 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
262 |
231 |
$12K |
| D2332 |
|
82 |
55 |
$8K |
| D2330 |
|
83 |
60 |
$5K |
| D2932 |
|
24 |
24 |
$4K |
| D1351 |
Sealant - per tooth |
65 |
27 |
$2K |