| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,263 |
1,311 |
$156K |
| D1110 |
Prophylaxis - adult |
2,921 |
2,629 |
$132K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,359 |
848 |
$115K |
| D0210 |
Intraoral - complete series of radiographic images |
2,038 |
1,773 |
$111K |
| D2335 |
|
674 |
342 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,448 |
2,213 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
2,154 |
1,927 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,029 |
2,727 |
$66K |
| D2394 |
|
558 |
328 |
$60K |
| D1206 |
Topical application of fluoride varnish |
2,144 |
1,967 |
$39K |
| D1120 |
Prophylaxis - child |
1,394 |
1,268 |
$39K |
| D0330 |
Panoramic radiographic image |
871 |
747 |
$35K |
| D0274 |
Bitewings - four radiographic images |
998 |
912 |
$33K |
| D2332 |
|
296 |
186 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
522 |
358 |
$28K |
| D4346 |
|
118 |
110 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,197 |
1,791 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
814 |
675 |
$18K |
| D0272 |
Bitewings - two radiographic images |
311 |
291 |
$6K |
| D2331 |
|
44 |
31 |
$4K |
| D2330 |
|
39 |
28 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
166 |
82 |
$1K |
| D1351 |
Sealant - per tooth |
35 |
13 |
$821.80 |
| D9986 |
|
49 |
48 |
$0.00 |