| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,833 |
1,687 |
$294K |
| D1110 |
Prophylaxis - adult |
4,930 |
4,543 |
$246K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,102 |
1,292 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
6,070 |
5,419 |
$147K |
| D1120 |
Prophylaxis - child |
3,739 |
3,294 |
$134K |
| D0274 |
Bitewings - four radiographic images |
2,904 |
2,657 |
$101K |
| D0330 |
Panoramic radiographic image |
1,706 |
1,587 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,789 |
4,282 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
2,121 |
1,916 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
389 |
288 |
$53K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,168 |
1,109 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
641 |
244 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
1,461 |
1,296 |
$22K |
| D0272 |
Bitewings - two radiographic images |
908 |
776 |
$20K |
| D2331 |
|
172 |
122 |
$16K |
| D1351 |
Sealant - per tooth |
164 |
24 |
$5K |
| D2332 |
|
35 |
24 |
$4K |
| D2330 |
|
36 |
26 |
$3K |
| D1320 |
|
40 |
40 |
$1K |
| D0190 |
|
120 |
89 |
$639.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
13 |
$616.00 |
| D0180 |
|
15 |
15 |
$525.99 |
| D1206 |
Topical application of fluoride varnish |
15 |
14 |
$300.00 |
| D9995 |
|
42 |
24 |
$130.00 |