| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,279 |
1,286 |
$409K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,020 |
1,353 |
$319K |
| D0120 |
Periodic oral evaluation - established patient |
3,109 |
2,900 |
$95K |
| D1120 |
Prophylaxis - child |
2,314 |
2,129 |
$82K |
| D1110 |
Prophylaxis - adult |
835 |
788 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,303 |
2,122 |
$39K |
| D3120 |
|
1,565 |
633 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
982 |
739 |
$34K |
| D1206 |
Topical application of fluoride varnish |
798 |
731 |
$16K |
| D0272 |
Bitewings - two radiographic images |
360 |
329 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
865 |
764 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
841 |
409 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
167 |
138 |
$6K |
| D0274 |
Bitewings - four radiographic images |
148 |
143 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
94 |
77 |
$5K |
| D1351 |
Sealant - per tooth |
82 |
26 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
15 |
$2K |
| D0330 |
Panoramic radiographic image |
17 |
12 |
$659.25 |
| D9975 |
|
14 |
12 |
$0.00 |