| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,635 |
1,752 |
$303K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,673 |
1,452 |
$285K |
| D1120 |
Prophylaxis - child |
4,815 |
3,706 |
$107K |
| D0140 |
Limited oral evaluation - problem focused |
2,889 |
2,265 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,305 |
2,292 |
$88K |
| D1206 |
Topical application of fluoride varnish |
4,092 |
3,088 |
$74K |
| D0274 |
Bitewings - four radiographic images |
3,121 |
2,274 |
$67K |
| D2394 |
|
549 |
328 |
$62K |
| D0330 |
Panoramic radiographic image |
1,411 |
1,142 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
564 |
524 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,273 |
1,185 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
433 |
155 |
$20K |
| D1351 |
Sealant - per tooth |
469 |
119 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
154 |
65 |
$11K |
| D0350 |
|
416 |
396 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
273 |
243 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
457 |
295 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
316 |
266 |
$3K |