| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,058 |
1,953 |
$432K |
| D0120 |
Periodic oral evaluation - established patient |
7,803 |
7,582 |
$204K |
| D1110 |
Prophylaxis - adult |
5,029 |
4,780 |
$187K |
| D1120 |
Prophylaxis - child |
4,764 |
4,548 |
$129K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,609 |
1,030 |
$128K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,219 |
4,979 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,476 |
2,353 |
$78K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,885 |
1,638 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
4,997 |
4,685 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,631 |
4,161 |
$67K |
| D1206 |
Topical application of fluoride varnish |
3,231 |
3,110 |
$52K |
| D1351 |
Sealant - per tooth |
1,553 |
541 |
$43K |
| D0272 |
Bitewings - two radiographic images |
1,801 |
1,715 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
878 |
816 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
553 |
477 |
$24K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
148 |
86 |
$20K |
| D0330 |
Panoramic radiographic image |
266 |
243 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
170 |
82 |
$10K |
| D0240 |
|
340 |
155 |
$5K |
| D4355 |
|
17 |
15 |
$967.16 |