| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,941 |
1,124 |
$150K |
| D0120 |
Periodic oral evaluation - established patient |
3,752 |
3,644 |
$69K |
| D1120 |
Prophylaxis - child |
2,530 |
2,441 |
$68K |
| D1110 |
Prophylaxis - adult |
1,722 |
1,637 |
$60K |
| D1206 |
Topical application of fluoride varnish |
2,136 |
2,056 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,231 |
1,948 |
$48K |
| D1999 |
|
2,230 |
1,851 |
$40K |
| D0330 |
Panoramic radiographic image |
1,012 |
961 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,353 |
2,280 |
$33K |
| D7240 |
Removal of impacted tooth - completely bony |
113 |
31 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,007 |
967 |
$16K |
| D0274 |
Bitewings - four radiographic images |
778 |
729 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
149 |
108 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
556 |
516 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,157 |
1,051 |
$12K |
| D9222 |
|
45 |
44 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
96 |
65 |
$5K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
45 |
44 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
73 |
71 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
16 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
43 |
24 |
$420.00 |