| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,024 |
976 |
$147K |
| D1110 |
Prophylaxis - adult |
2,872 |
2,762 |
$115K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,652 |
994 |
$98K |
| D0120 |
Periodic oral evaluation - established patient |
3,531 |
3,434 |
$82K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,375 |
3,268 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,020 |
1,956 |
$49K |
| D1120 |
Prophylaxis - child |
1,423 |
1,373 |
$44K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,296 |
1,121 |
$36K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
56 |
53 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
362 |
217 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
889 |
866 |
$25K |
| D0330 |
Panoramic radiographic image |
625 |
604 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,944 |
1,726 |
$20K |
| D2950 |
|
182 |
154 |
$20K |
| D2750 |
|
22 |
17 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
460 |
445 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
20 |
13 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,155 |
651 |
$8K |
| D4346 |
|
107 |
96 |
$4K |
| D0272 |
Bitewings - two radiographic images |
228 |
219 |
$4K |
| D1206 |
Topical application of fluoride varnish |
111 |
107 |
$2K |
| D1351 |
Sealant - per tooth |
53 |
17 |
$2K |
| D2331 |
|
21 |
14 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
14 |
$811.07 |
| D0603 |
|
56 |
55 |
$0.00 |
| D0602 |
|
13 |
13 |
$0.00 |