| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,820 |
1,059 |
$646K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,078 |
697 |
$324K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
690 |
352 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,853 |
1,801 |
$77K |
| D1110 |
Prophylaxis - adult |
1,198 |
1,176 |
$60K |
| D0210 |
Intraoral - complete series of radiographic images |
588 |
563 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,498 |
1,486 |
$42K |
| D2740 |
Crown - porcelain/ceramic |
38 |
24 |
$32K |
| D1120 |
Prophylaxis - child |
807 |
799 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
820 |
748 |
$26K |
| D2332 |
|
167 |
59 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
760 |
760 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,594 |
1,576 |
$20K |
| D0274 |
Bitewings - four radiographic images |
645 |
645 |
$19K |
| D1208 |
Topical application of fluoride, excluding varnish |
834 |
818 |
$10K |
| D1351 |
Sealant - per tooth |
266 |
76 |
$9K |
| D1206 |
Topical application of fluoride varnish |
287 |
287 |
$6K |
| D2330 |
|
39 |
17 |
$4K |
| D0272 |
Bitewings - two radiographic images |
151 |
149 |
$3K |
| D0330 |
Panoramic radiographic image |
37 |
37 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
28 |
26 |
$946.70 |