| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,896 |
1,734 |
$399K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,717 |
2,208 |
$386K |
| D1110 |
Prophylaxis - adult |
3,719 |
3,637 |
$175K |
| D2394 |
|
1,518 |
785 |
$174K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,114 |
1,070 |
$137K |
| D0120 |
Periodic oral evaluation - established patient |
4,764 |
4,687 |
$129K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,549 |
2,248 |
$82K |
| D1120 |
Prophylaxis - child |
2,277 |
2,234 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
5,199 |
4,929 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,301 |
3,250 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,280 |
1,210 |
$57K |
| D2332 |
|
457 |
234 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,921 |
3,971 |
$54K |
| D0272 |
Bitewings - two radiographic images |
2,776 |
2,641 |
$49K |
| D2335 |
|
237 |
123 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
748 |
706 |
$38K |
| D0330 |
Panoramic radiographic image |
103 |
102 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
172 |
164 |
$4K |
| D1206 |
Topical application of fluoride varnish |
144 |
144 |
$3K |
| D3110 |
|
69 |
41 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
26 |
26 |
$1K |
| D0350 |
|
14 |
14 |
$0.00 |