| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,662 |
1,346 |
$125K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,952 |
854 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,216 |
751 |
$67K |
| D1110 |
Prophylaxis - adult |
2,022 |
1,937 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,249 |
2,169 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
690 |
665 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
1,263 |
1,160 |
$21K |
| D0274 |
Bitewings - four radiographic images |
1,310 |
1,255 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,622 |
1,577 |
$19K |
| D1120 |
Prophylaxis - child |
993 |
960 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,555 |
2,419 |
$17K |
| D2394 |
|
235 |
163 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
887 |
840 |
$16K |
| D2332 |
|
285 |
177 |
$15K |
| D2331 |
|
309 |
207 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
359 |
177 |
$11K |
| D0272 |
Bitewings - two radiographic images |
720 |
700 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
266 |
232 |
$9K |
| D0350 |
|
148 |
76 |
$8K |
| D1206 |
Topical application of fluoride varnish |
553 |
517 |
$6K |
| D2335 |
|
59 |
38 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
522 |
345 |
$2K |
| D0330 |
Panoramic radiographic image |
59 |
56 |
$2K |
| D9215 |
|
2,639 |
2,164 |
$0.00 |
| D1999 |
|
1,110 |
885 |
$0.00 |