| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,760 |
1,977 |
$274K |
| D1120 |
Prophylaxis - child |
8,911 |
8,825 |
$249K |
| D1208 |
Topical application of fluoride, excluding varnish |
10,956 |
10,854 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
10,370 |
10,274 |
$175K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,054 |
3,001 |
$88K |
| D1110 |
Prophylaxis - adult |
2,235 |
2,217 |
$87K |
| D0272 |
Bitewings - two radiographic images |
3,703 |
3,661 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,154 |
706 |
$61K |
| D1351 |
Sealant - per tooth |
2,039 |
583 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
399 |
236 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,034 |
1,021 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,366 |
2,342 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
688 |
684 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,190 |
1,029 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
127 |
98 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
191 |
187 |
$7K |
| D0240 |
|
619 |
569 |
$5K |
| D0330 |
Panoramic radiographic image |
78 |
78 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
14 |
12 |
$347.62 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$0.00 |