| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,363 |
2,120 |
$280K |
| D0120 |
Periodic oral evaluation - established patient |
10,985 |
10,661 |
$275K |
| D1110 |
Prophylaxis - adult |
6,447 |
6,183 |
$269K |
| D1206 |
Topical application of fluoride varnish |
10,757 |
10,334 |
$188K |
| D1120 |
Prophylaxis - child |
6,450 |
6,211 |
$144K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,139 |
1,234 |
$106K |
| D0330 |
Panoramic radiographic image |
2,841 |
2,679 |
$96K |
| D0274 |
Bitewings - four radiographic images |
5,522 |
5,254 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,888 |
1,718 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
4,809 |
4,526 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,852 |
1,785 |
$25K |
| D0272 |
Bitewings - two radiographic images |
2,400 |
2,300 |
$23K |
| D1999 |
|
2,056 |
1,764 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
671 |
643 |
$15K |
| D9999 |
Unspecified adjunctive procedure, by report |
449 |
428 |
$12K |
| D1351 |
Sealant - per tooth |
434 |
132 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
73 |
39 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
330 |
293 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,171 |
1,629 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
46 |
27 |
$4K |
| D9310 |
|
12 |
12 |
$0.00 |