| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,703 |
1,361 |
$285K |
| D1110 |
Prophylaxis - adult |
3,863 |
3,572 |
$187K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,951 |
1,042 |
$166K |
| D1120 |
Prophylaxis - child |
4,447 |
4,147 |
$158K |
| D0120 |
Periodic oral evaluation - established patient |
5,841 |
5,431 |
$154K |
| D0330 |
Panoramic radiographic image |
2,292 |
2,123 |
$143K |
| D0274 |
Bitewings - four radiographic images |
3,735 |
3,459 |
$130K |
| D1206 |
Topical application of fluoride varnish |
5,168 |
4,708 |
$119K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,631 |
2,483 |
$111K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
699 |
391 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,241 |
2,179 |
$51K |
| D2140 |
|
580 |
326 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
222 |
125 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
718 |
595 |
$26K |
| D0272 |
Bitewings - two radiographic images |
552 |
513 |
$15K |
| D2160 |
|
90 |
68 |
$10K |
| D2331 |
|
65 |
25 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
38 |
$5K |
| D1351 |
Sealant - per tooth |
170 |
41 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
153 |
105 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
41 |
40 |
$680.70 |
| D8660 |
|
14 |
14 |
$467.88 |
| D1999 |
|
14 |
14 |
$0.00 |