| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,231 |
771 |
$191K |
| D1120 |
Prophylaxis - child |
2,968 |
2,909 |
$114K |
| D0120 |
Periodic oral evaluation - established patient |
1,986 |
1,930 |
$57K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
410 |
165 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,540 |
2,497 |
$33K |
| D1110 |
Prophylaxis - adult |
597 |
590 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,301 |
1,275 |
$20K |
| D0274 |
Bitewings - four radiographic images |
983 |
956 |
$19K |
| D0330 |
Panoramic radiographic image |
745 |
716 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,322 |
1,225 |
$17K |
| D1206 |
Topical application of fluoride varnish |
777 |
759 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
372 |
368 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
246 |
222 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
112 |
50 |
$8K |
| D9248 |
|
85 |
80 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
74 |
74 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
25 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
164 |
136 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
35 |
27 |
$942.72 |
| D0240 |
|
63 |
21 |
$704.00 |