| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,483 |
2,390 |
$240K |
| D1110 |
Prophylaxis - adult |
6,065 |
4,859 |
$217K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,865 |
2,006 |
$156K |
| D0120 |
Periodic oral evaluation - established patient |
8,686 |
6,957 |
$145K |
| D1351 |
Sealant - per tooth |
7,555 |
1,432 |
$133K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,521 |
6,033 |
$115K |
| D0272 |
Bitewings - two radiographic images |
6,371 |
5,127 |
$114K |
| D1120 |
Prophylaxis - child |
4,372 |
3,446 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
2,142 |
1,686 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,987 |
1,598 |
$51K |
| D0330 |
Panoramic radiographic image |
1,546 |
1,159 |
$46K |
| D0274 |
Bitewings - four radiographic images |
2,142 |
1,734 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
453 |
274 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,665 |
1,189 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,967 |
1,250 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,116 |
2,404 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
186 |
114 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
719 |
488 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
15 |
12 |
$308.96 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
24 |
17 |
$0.00 |