| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,061 |
1,381 |
$401K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,585 |
1,316 |
$349K |
| D1120 |
Prophylaxis - child |
2,632 |
2,570 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,355 |
3,263 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
743 |
314 |
$64K |
| D1110 |
Prophylaxis - adult |
1,380 |
1,313 |
$59K |
| D1206 |
Topical application of fluoride varnish |
2,804 |
2,731 |
$52K |
| D0272 |
Bitewings - two radiographic images |
2,396 |
2,341 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
490 |
206 |
$43K |
| D0274 |
Bitewings - four radiographic images |
1,312 |
1,241 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,267 |
1,153 |
$39K |
| D0330 |
Panoramic radiographic image |
655 |
638 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
799 |
738 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,228 |
1,145 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
421 |
394 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
687 |
671 |
$12K |
| D2394 |
|
65 |
24 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
576 |
524 |
$6K |
| D9986 |
|
61 |
58 |
$0.00 |