| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,530 |
1,009 |
$90K |
| D1120 |
Prophylaxis - child |
1,642 |
1,568 |
$70K |
| D0330 |
Panoramic radiographic image |
1,770 |
1,626 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,331 |
2,103 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,033 |
723 |
$50K |
| D1110 |
Prophylaxis - adult |
1,265 |
1,182 |
$48K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,344 |
2,242 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,515 |
1,447 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,360 |
1,211 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,383 |
1,301 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
707 |
670 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
810 |
691 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
258 |
179 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
2,544 |
2,235 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
442 |
241 |
$14K |
| D1351 |
Sealant - per tooth |
736 |
268 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,052 |
1,034 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
41 |
38 |
$877.20 |
| D0270 |
|
49 |
48 |
$301.25 |
| D0210 |
Intraoral - complete series of radiographic images |
34 |
13 |
$47.25 |
| D0603 |
|
2,084 |
1,902 |
$0.00 |
| D0601 |
|
678 |
634 |
$0.00 |
| D0602 |
|
74 |
70 |
$0.00 |