| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,881 |
2,175 |
$333K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
11,035 |
10,665 |
$322K |
| D0120 |
Periodic oral evaluation - established patient |
12,351 |
12,219 |
$300K |
| D1110 |
Prophylaxis - adult |
6,582 |
6,508 |
$284K |
| D1206 |
Topical application of fluoride varnish |
13,074 |
12,911 |
$274K |
| D1120 |
Prophylaxis - child |
6,859 |
6,762 |
$230K |
| D0274 |
Bitewings - four radiographic images |
5,675 |
5,594 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,273 |
1,186 |
$141K |
| D0330 |
Panoramic radiographic image |
2,917 |
2,878 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,207 |
696 |
$89K |
| D0220 |
Intraoral - periapical first radiographic image |
4,579 |
4,289 |
$55K |
| D1351 |
Sealant - per tooth |
1,634 |
642 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,871 |
1,840 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
793 |
769 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
361 |
201 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,868 |
1,156 |
$17K |
| D2394 |
|
146 |
83 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
171 |
162 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
63 |
62 |
$1K |
| D1999 |
|
48 |
42 |
$0.00 |