| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,005 |
1,729 |
$330K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,332 |
1,128 |
$243K |
| D1120 |
Prophylaxis - child |
4,106 |
3,735 |
$161K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,566 |
848 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,259 |
2,076 |
$115K |
| D1206 |
Topical application of fluoride varnish |
4,089 |
3,678 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
3,407 |
3,098 |
$94K |
| D0274 |
Bitewings - four radiographic images |
2,598 |
2,305 |
$93K |
| D0330 |
Panoramic radiographic image |
1,082 |
970 |
$74K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,490 |
1,068 |
$67K |
| D7140 |
Extraction, erupted tooth or exposed root |
514 |
267 |
$48K |
| D1110 |
Prophylaxis - adult |
1,201 |
1,056 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,075 |
929 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
1,722 |
1,527 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
381 |
356 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,223 |
521 |
$17K |
| D1351 |
Sealant - per tooth |
334 |
108 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
402 |
397 |
$10K |
| D0272 |
Bitewings - two radiographic images |
100 |
94 |
$3K |
| D2394 |
|
16 |
12 |
$2K |