| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,392 |
2,936 |
$420K |
| D0120 |
Periodic oral evaluation - established patient |
4,572 |
4,551 |
$259K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,201 |
3,143 |
$203K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,665 |
1,831 |
$197K |
| D1110 |
Prophylaxis - adult |
2,311 |
2,288 |
$190K |
| D1120 |
Prophylaxis - child |
4,857 |
4,820 |
$184K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,221 |
1,368 |
$175K |
| D9430 |
|
4,894 |
4,172 |
$155K |
| D0350 |
|
15,115 |
3,939 |
$142K |
| D0210 |
Intraoral - complete series of radiographic images |
2,799 |
2,754 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
23,784 |
6,079 |
$99K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,179 |
7,120 |
$90K |
| D1351 |
Sealant - per tooth |
2,947 |
744 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,860 |
2,841 |
$58K |
| D4341 |
|
703 |
248 |
$49K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
94 |
73 |
$45K |
| D4910 |
|
420 |
420 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
2,723 |
2,676 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
367 |
192 |
$21K |
| D1320 |
|
1,167 |
1,150 |
$20K |
| D0330 |
Panoramic radiographic image |
217 |
215 |
$6K |
| D2954 |
|
59 |
50 |
$6K |
| D2331 |
|
61 |
40 |
$5K |
| D2330 |
|
45 |
25 |
$3K |
| D2394 |
|
29 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
195 |
195 |
$2K |
| D1310 |
|
92 |
90 |
$2K |
| D0240 |
|
82 |
42 |
$780.00 |
| D9993 |
|
73 |
71 |
$696.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
13 |
$520.00 |
| D0601 |
|
149 |
138 |
$360.00 |
| D0270 |
|
29 |
29 |
$145.00 |
| D1999 |
|
281 |
271 |
$107.00 |
| D0351 |
|
50 |
50 |
$0.00 |