| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,016 |
969 |
$97K |
| D1110 |
Prophylaxis - adult |
2,282 |
1,976 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
3,031 |
2,639 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,885 |
2,491 |
$39K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
718 |
409 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,194 |
1,023 |
$31K |
| D1351 |
Sealant - per tooth |
1,632 |
348 |
$31K |
| D1120 |
Prophylaxis - child |
1,309 |
1,143 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
643 |
549 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
957 |
812 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,154 |
906 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
766 |
620 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
507 |
323 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
414 |
157 |
$17K |
| D0272 |
Bitewings - two radiographic images |
771 |
673 |
$12K |
| D0330 |
Panoramic radiographic image |
299 |
202 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
719 |
594 |
$6K |
| D9920 |
|
208 |
144 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
67 |
29 |
$643.00 |
| D0431 |
|
122 |
106 |
$0.00 |
| D2394 |
|
20 |
12 |
$0.00 |