| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,362 |
2,073 |
$179K |
| D1110 |
Prophylaxis - adult |
4,767 |
4,478 |
$169K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,419 |
1,999 |
$159K |
| D0120 |
Periodic oral evaluation - established patient |
6,755 |
6,329 |
$120K |
| D0274 |
Bitewings - four radiographic images |
3,263 |
3,073 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,192 |
3,937 |
$66K |
| D1120 |
Prophylaxis - child |
2,518 |
2,363 |
$51K |
| D0330 |
Panoramic radiographic image |
966 |
896 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
608 |
575 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
229 |
167 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
533 |
433 |
$10K |
| D0272 |
Bitewings - two radiographic images |
896 |
835 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,249 |
1,172 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
110 |
70 |
$4K |
| D2140 |
|
61 |
36 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
43 |
32 |
$2K |
| D2331 |
|
45 |
25 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
14 |
$331.94 |
| D0230 |
Intraoral - periapical each additional radiographic image |
64 |
51 |
$304.50 |
| D1999 |
|
51 |
45 |
$0.00 |