| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,483 |
4,163 |
$762K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,737 |
2,354 |
$636K |
| D0120 |
Periodic oral evaluation - established patient |
23,745 |
23,491 |
$495K |
| D1120 |
Prophylaxis - child |
16,015 |
15,850 |
$478K |
| D1110 |
Prophylaxis - adult |
10,006 |
9,893 |
$449K |
| D1208 |
Topical application of fluoride, excluding varnish |
25,135 |
24,878 |
$375K |
| D0330 |
Panoramic radiographic image |
6,330 |
6,286 |
$304K |
| D0220 |
Intraoral - periapical first radiographic image |
18,762 |
18,584 |
$281K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,190 |
16,122 |
$219K |
| D0274 |
Bitewings - four radiographic images |
7,147 |
7,106 |
$214K |
| D1351 |
Sealant - per tooth |
5,770 |
1,532 |
$139K |
| D0272 |
Bitewings - two radiographic images |
6,798 |
6,768 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,886 |
3,847 |
$115K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,328 |
4,167 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,511 |
1,091 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
2,576 |
2,527 |
$77K |
| D7111 |
|
1,137 |
563 |
$68K |
| D2335 |
|
244 |
97 |
$30K |
| D2332 |
|
185 |
115 |
$20K |
| D3120 |
|
159 |
126 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
18 |
13 |
$2K |
| D3221 |
|
15 |
12 |
$2K |
| D2330 |
|
17 |
15 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
28 |
15 |
$848.09 |