| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,460 |
1,836 |
$462K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,345 |
1,497 |
$351K |
| D1110 |
Prophylaxis - adult |
5,159 |
5,112 |
$225K |
| D0120 |
Periodic oral evaluation - established patient |
9,195 |
9,140 |
$214K |
| D1120 |
Prophylaxis - child |
5,715 |
5,681 |
$187K |
| D1206 |
Topical application of fluoride varnish |
8,710 |
8,651 |
$157K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
625 |
412 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,485 |
2,462 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
920 |
491 |
$92K |
| D0220 |
Intraoral - periapical first radiographic image |
7,229 |
7,076 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,603 |
5,537 |
$88K |
| D0274 |
Bitewings - four radiographic images |
2,815 |
2,793 |
$83K |
| D1351 |
Sealant - per tooth |
1,235 |
403 |
$42K |
| D0272 |
Bitewings - two radiographic images |
1,646 |
1,643 |
$34K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
327 |
193 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
973 |
948 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
908 |
829 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
415 |
411 |
$23K |
| D0330 |
Panoramic radiographic image |
162 |
162 |
$8K |
| D4342 |
|
47 |
25 |
$4K |
| D2160 |
|
35 |
24 |
$4K |
| D2394 |
|
19 |
12 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
41 |
$1K |
| D2330 |
|
14 |
12 |
$1K |
| D0270 |
|
28 |
28 |
$360.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
15 |
15 |
$167.40 |