| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,681 |
983 |
$172K |
| D0120 |
Periodic oral evaluation - established patient |
5,834 |
5,646 |
$141K |
| D1110 |
Prophylaxis - adult |
2,981 |
2,865 |
$108K |
| D0220 |
Intraoral - periapical first radiographic image |
4,884 |
4,649 |
$69K |
| D1120 |
Prophylaxis - child |
2,534 |
2,435 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,754 |
3,633 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
1,593 |
1,489 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
964 |
893 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,111 |
2,596 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,053 |
1,009 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
506 |
291 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
359 |
213 |
$28K |
| D0330 |
Panoramic radiographic image |
484 |
464 |
$23K |
| D0272 |
Bitewings - two radiographic images |
547 |
525 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
267 |
250 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
24 |
$7K |
| D1206 |
Topical application of fluoride varnish |
352 |
335 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
38 |
$6K |
| D4355 |
|
90 |
81 |
$5K |
| D9420 |
|
48 |
39 |
$4K |
| D1351 |
Sealant - per tooth |
107 |
28 |
$3K |
| D2394 |
|
18 |
16 |
$3K |
| D2331 |
|
23 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
14 |
13 |
$446.48 |