| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,826 |
823 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,805 |
3,725 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,547 |
724 |
$74K |
| D1110 |
Prophylaxis - adult |
1,926 |
1,876 |
$67K |
| D1206 |
Topical application of fluoride varnish |
4,226 |
4,103 |
$65K |
| D1120 |
Prophylaxis - child |
2,421 |
2,355 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,359 |
1,316 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
558 |
524 |
$18K |
| D0272 |
Bitewings - two radiographic images |
734 |
709 |
$7K |
| D1351 |
Sealant - per tooth |
353 |
142 |
$7K |
| D1999 |
|
573 |
480 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
29 |
17 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
13 |
$257.27 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$240.00 |
| D0220 |
Intraoral - periapical first radiographic image |
13 |
12 |
$95.04 |