| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,624 |
1,146 |
$163K |
| D1110 |
Prophylaxis - adult |
3,863 |
3,277 |
$120K |
| D1999 |
|
7,127 |
5,570 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
6,035 |
5,260 |
$100K |
| D1120 |
Prophylaxis - child |
4,182 |
3,557 |
$98K |
| D0330 |
Panoramic radiographic image |
2,921 |
2,168 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,977 |
3,000 |
$79K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,312 |
655 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
6,623 |
5,243 |
$57K |
| D0274 |
Bitewings - four radiographic images |
3,070 |
2,445 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,950 |
3,434 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,315 |
5,043 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,761 |
2,295 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,747 |
1,459 |
$36K |
| D1354 |
|
645 |
175 |
$23K |
| D2740 |
Crown - porcelain/ceramic |
34 |
13 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
158 |
75 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
288 |
180 |
$5K |
| D7240 |
Removal of impacted tooth - completely bony |
43 |
12 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
176 |
137 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
12 |
$2K |
| D2950 |
|
32 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
12 |
$132.00 |
| D9999 |
Unspecified adjunctive procedure, by report |
374 |
207 |
$0.00 |