| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,806 |
1,300 |
$219K |
| D1206 |
Topical application of fluoride varnish |
6,822 |
6,709 |
$125K |
| D1120 |
Prophylaxis - child |
4,050 |
3,995 |
$121K |
| D1110 |
Prophylaxis - adult |
2,768 |
2,710 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
6,153 |
6,051 |
$109K |
| D0274 |
Bitewings - four radiographic images |
2,219 |
2,174 |
$54K |
| D1351 |
Sealant - per tooth |
1,814 |
531 |
$53K |
| D9920 |
|
532 |
490 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
526 |
209 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
210 |
129 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
318 |
177 |
$20K |
| D0272 |
Bitewings - two radiographic images |
895 |
890 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
331 |
326 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
279 |
273 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
313 |
293 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
681 |
667 |
$6K |
| D2335 |
|
39 |
13 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
18 |
18 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
319 |
159 |
$2K |
| D9110 |
|
12 |
12 |
$755.52 |
| D0140 |
Limited oral evaluation - problem focused |
27 |
24 |
$670.41 |