| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
6,555 |
1,406 |
$558K |
| D2394 |
|
5,019 |
1,420 |
$495K |
| D2330 |
|
1,910 |
457 |
$110K |
| D1110 |
Prophylaxis - adult |
2,272 |
2,120 |
$73K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
983 |
393 |
$71K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,170 |
2,771 |
$64K |
| D0120 |
Periodic oral evaluation - established patient |
3,518 |
3,350 |
$60K |
| D0330 |
Panoramic radiographic image |
1,848 |
1,673 |
$50K |
| D1120 |
Prophylaxis - child |
1,910 |
1,814 |
$50K |
| D1999 |
|
2,713 |
2,352 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,117 |
2,928 |
$41K |
| D0272 |
Bitewings - two radiographic images |
2,827 |
2,692 |
$36K |
| D1206 |
Topical application of fluoride varnish |
954 |
890 |
$21K |
| D1354 |
|
568 |
116 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
520 |
444 |
$10K |
| D0274 |
Bitewings - four radiographic images |
623 |
581 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
392 |
339 |
$9K |
| D7230 |
|
52 |
14 |
$8K |
| D7960 |
|
31 |
30 |
$5K |
| D2335 |
|
69 |
25 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
492 |
414 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
67 |
32 |
$4K |
| D2950 |
|
32 |
13 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
227 |
164 |
$2K |
| D1351 |
Sealant - per tooth |
99 |
29 |
$2K |
| D3120 |
|
82 |
19 |
$1K |
| D9110 |
|
20 |
13 |
$280.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
44 |
21 |
$0.00 |