| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16,737 |
7,099 |
$1.63M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
8,327 |
4,238 |
$931K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,871 |
4,487 |
$714K |
| D0120 |
Periodic oral evaluation - established patient |
14,115 |
12,467 |
$329K |
| D1110 |
Prophylaxis - adult |
8,339 |
7,152 |
$277K |
| D0230 |
Intraoral - periapical each additional radiographic image |
19,678 |
8,722 |
$202K |
| D1120 |
Prophylaxis - child |
7,847 |
7,008 |
$196K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,544 |
11,070 |
$190K |
| D0220 |
Intraoral - periapical first radiographic image |
13,166 |
10,765 |
$169K |
| D0274 |
Bitewings - four radiographic images |
5,448 |
4,623 |
$145K |
| D0330 |
Panoramic radiographic image |
3,010 |
2,528 |
$143K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,022 |
2,646 |
$128K |
| D0140 |
Limited oral evaluation - problem focused |
3,439 |
2,725 |
$106K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,613 |
2,125 |
$92K |
| D0272 |
Bitewings - two radiographic images |
3,359 |
3,049 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
233 |
154 |
$15K |
| D4355 |
|
328 |
196 |
$13K |
| D2332 |
|
193 |
63 |
$11K |
| D4341 |
|
85 |
13 |
$4K |
| D1351 |
Sealant - per tooth |
51 |
12 |
$1K |
| D1206 |
Topical application of fluoride varnish |
97 |
96 |
$1K |
| D2330 |
|
15 |
12 |
$964.60 |