| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,097 |
2,201 |
$520K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,795 |
1,062 |
$221K |
| D1110 |
Prophylaxis - adult |
4,191 |
3,972 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
6,107 |
5,758 |
$153K |
| D0274 |
Bitewings - four radiographic images |
3,090 |
2,911 |
$94K |
| D0330 |
Panoramic radiographic image |
1,633 |
1,499 |
$87K |
| D0220 |
Intraoral - periapical first radiographic image |
5,848 |
5,400 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,989 |
1,831 |
$82K |
| D1120 |
Prophylaxis - child |
3,012 |
2,812 |
$80K |
| D1206 |
Topical application of fluoride varnish |
4,780 |
4,562 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,390 |
4,693 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
880 |
567 |
$68K |
| D0140 |
Limited oral evaluation - problem focused |
1,241 |
1,144 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,314 |
1,213 |
$23K |
| D4355 |
|
288 |
272 |
$19K |
| D1351 |
Sealant - per tooth |
485 |
116 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
672 |
563 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
154 |
119 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
92 |
36 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
15 |
$3K |
| D2332 |
|
25 |
13 |
$3K |
| D2331 |
|
26 |
13 |
$2K |
| D4346 |
|
13 |
12 |
$394.30 |