| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,548 |
1,947 |
$256K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,194 |
1,629 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
5,660 |
5,595 |
$129K |
| D1351 |
Sealant - per tooth |
4,915 |
1,195 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,693 |
4,568 |
$105K |
| D1120 |
Prophylaxis - child |
3,689 |
3,652 |
$100K |
| D1110 |
Prophylaxis - adult |
2,731 |
2,705 |
$92K |
| D0272 |
Bitewings - two radiographic images |
5,093 |
5,058 |
$56K |
| D1999 |
|
4,957 |
4,226 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
983 |
983 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
923 |
376 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,803 |
1,746 |
$41K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
319 |
257 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,045 |
1,040 |
$25K |
| D0330 |
Panoramic radiographic image |
1,878 |
1,852 |
$23K |
| D0274 |
Bitewings - four radiographic images |
798 |
772 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,087 |
1,046 |
$7K |
| D2331 |
|
63 |
40 |
$4K |
| D2332 |
|
23 |
17 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
60 |
56 |
$2K |
| D0240 |
|
41 |
39 |
$290.36 |