| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,674 |
3,441 |
$364K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,977 |
2,394 |
$307K |
| D1110 |
Prophylaxis - adult |
4,738 |
4,580 |
$191K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,058 |
1,895 |
$187K |
| D0120 |
Periodic oral evaluation - established patient |
7,619 |
7,362 |
$159K |
| D2394 |
|
1,550 |
1,098 |
$136K |
| D0210 |
Intraoral - complete series of radiographic images |
1,959 |
1,869 |
$119K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,557 |
6,351 |
$113K |
| D2335 |
|
918 |
466 |
$111K |
| D1120 |
Prophylaxis - child |
4,577 |
4,429 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,262 |
3,146 |
$102K |
| D0274 |
Bitewings - four radiographic images |
4,008 |
3,876 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,053 |
4,336 |
$55K |
| D0330 |
Panoramic radiographic image |
695 |
668 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,677 |
1,568 |
$45K |
| D2332 |
|
466 |
327 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
5,200 |
4,996 |
$32K |
| D0272 |
Bitewings - two radiographic images |
2,106 |
2,031 |
$27K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
186 |
103 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
92 |
78 |
$6K |
| D2160 |
|
90 |
62 |
$6K |
| D2140 |
|
63 |
44 |
$3K |
| D2331 |
|
14 |
14 |
$933.24 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
125 |
117 |
$0.00 |