| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,019 |
1,180 |
$177K |
| D1120 |
Prophylaxis - child |
3,315 |
3,315 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,479 |
895 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,823 |
3,823 |
$77K |
| D1110 |
Prophylaxis - adult |
1,719 |
1,719 |
$74K |
| D0274 |
Bitewings - four radiographic images |
2,339 |
2,339 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,959 |
1,825 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,398 |
3,398 |
$50K |
| D0330 |
Panoramic radiographic image |
1,055 |
1,055 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
2,809 |
2,776 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
518 |
302 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,273 |
1,709 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
927 |
904 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,844 |
1,844 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
669 |
669 |
$19K |
| D0240 |
|
941 |
837 |
$16K |
| D1351 |
Sealant - per tooth |
694 |
254 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
27 |
$5K |
| D0272 |
Bitewings - two radiographic images |
287 |
287 |
$5K |
| D0601 |
|
176 |
176 |
$2K |
| D0602 |
|
162 |
162 |
$1K |
| D0603 |
|
133 |
133 |
$1K |
| D3120 |
|
22 |
13 |
$540.05 |