| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,717 |
1,163 |
$194K |
| D1120 |
Prophylaxis - child |
3,587 |
3,537 |
$102K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,065 |
611 |
$95K |
| D1206 |
Topical application of fluoride varnish |
4,966 |
4,898 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
4,187 |
4,139 |
$70K |
| D1110 |
Prophylaxis - adult |
1,356 |
1,331 |
$52K |
| D0274 |
Bitewings - four radiographic images |
1,954 |
1,925 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,058 |
777 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
673 |
643 |
$19K |
| D9920 |
|
167 |
153 |
$11K |
| D3120 |
|
502 |
271 |
$8K |
| D0330 |
Panoramic radiographic image |
221 |
219 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
472 |
434 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
36 |
26 |
$1K |
| D1351 |
Sealant - per tooth |
124 |
45 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
13 |
$737.19 |
| D0230 |
Intraoral - periapical each additional radiographic image |
40 |
25 |
$276.07 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
26 |
$0.00 |