| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
10,334 |
6,103 |
$1.00M |
| D0120 |
Periodic oral evaluation - established patient |
21,054 |
20,151 |
$592K |
| D1110 |
Prophylaxis - adult |
11,354 |
10,653 |
$552K |
| D1120 |
Prophylaxis - child |
12,408 |
12,330 |
$461K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,147 |
2,773 |
$291K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,403 |
1,701 |
$276K |
| D0210 |
Intraoral - complete series of radiographic images |
4,314 |
4,074 |
$267K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,694 |
12,606 |
$266K |
| D0272 |
Bitewings - two radiographic images |
7,264 |
7,062 |
$157K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,194 |
2,907 |
$151K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,000 |
2,817 |
$117K |
| T2003 |
Non-emergency transportation; encounter/trip |
8,784 |
2,681 |
$116K |
| D1206 |
Topical application of fluoride varnish |
4,232 |
4,202 |
$109K |
| D1351 |
Sealant - per tooth |
3,067 |
980 |
$93K |
| D0220 |
Intraoral - periapical first radiographic image |
2,389 |
2,065 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
374 |
222 |
$25K |
| D0274 |
Bitewings - four radiographic images |
366 |
242 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
47 |
36 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
104 |
103 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
88 |
87 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
157 |
96 |
$1K |