| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,036 |
1,165 |
$165K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,062 |
2,823 |
$126K |
| D1110 |
Prophylaxis - adult |
2,536 |
2,400 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,407 |
864 |
$87K |
| D0210 |
Intraoral - complete series of radiographic images |
1,686 |
1,517 |
$68K |
| D0330 |
Panoramic radiographic image |
1,494 |
1,389 |
$65K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
378 |
256 |
$37K |
| D1120 |
Prophylaxis - child |
1,102 |
1,092 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
1,317 |
1,283 |
$33K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
820 |
684 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,348 |
1,331 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,346 |
1,338 |
$26K |
| D4341 |
|
220 |
63 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
640 |
596 |
$8K |
| D1206 |
Topical application of fluoride varnish |
165 |
165 |
$4K |
| D1351 |
Sealant - per tooth |
106 |
42 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
544 |
211 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
14 |
$3K |
| D2394 |
|
20 |
14 |
$2K |
| D9248 |
|
12 |
12 |
$2K |
| D3110 |
|
21 |
12 |
$726.94 |
| D0274 |
Bitewings - four radiographic images |
28 |
26 |
$308.70 |
| D1330 |
|
183 |
171 |
$0.00 |