| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,561 |
1,977 |
$243K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,153 |
1,699 |
$188K |
| D2394 |
|
1,423 |
932 |
$111K |
| D1120 |
Prophylaxis - child |
2,277 |
2,177 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,953 |
2,802 |
$74K |
| D0274 |
Bitewings - four radiographic images |
1,580 |
1,500 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,454 |
2,348 |
$35K |
| D1110 |
Prophylaxis - adult |
575 |
551 |
$27K |
| D0330 |
Panoramic radiographic image |
575 |
552 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
454 |
259 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,369 |
1,217 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
291 |
240 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
381 |
372 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
981 |
370 |
$8K |
| D0272 |
Bitewings - two radiographic images |
179 |
170 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
54 |
40 |
$3K |
| D3110 |
|
125 |
76 |
$1K |
| D1999 |
|
278 |
206 |
$0.00 |