| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,291 |
1,014 |
$17K |
| D1120 |
Prophylaxis - child |
4,974 |
4,872 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
4,476 |
4,407 |
$7K |
| D1206 |
Topical application of fluoride varnish |
1,921 |
1,918 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,796 |
3,315 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,266 |
1,224 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
517 |
288 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,820 |
3,726 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,938 |
1,896 |
$2K |
| D1110 |
Prophylaxis - adult |
657 |
646 |
$2K |
| D0330 |
Panoramic radiographic image |
477 |
470 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,919 |
3,794 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
890 |
833 |
$1K |
| D0274 |
Bitewings - four radiographic images |
899 |
876 |
$1K |
| D1351 |
Sealant - per tooth |
440 |
174 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
214 |
206 |
$699.02 |
| D1999 |
|
909 |
801 |
$507.30 |
| D9248 |
|
113 |
110 |
$495.48 |
| D7140 |
Extraction, erupted tooth or exposed root |
67 |
40 |
$429.10 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
86 |
39 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
29 |
$0.00 |