| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,585 |
2,549 |
$492K |
| D1120 |
Prophylaxis - child |
17,372 |
13,725 |
$400K |
| D0120 |
Periodic oral evaluation - established patient |
12,590 |
10,991 |
$306K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,584 |
11,510 |
$192K |
| D0140 |
Limited oral evaluation - problem focused |
7,538 |
4,772 |
$189K |
| D0330 |
Panoramic radiographic image |
4,492 |
3,780 |
$163K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,629 |
723 |
$106K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,517 |
871 |
$105K |
| D0274 |
Bitewings - four radiographic images |
4,352 |
3,538 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,299 |
2,874 |
$72K |
| D0220 |
Intraoral - periapical first radiographic image |
3,862 |
2,962 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,562 |
1,369 |
$27K |
| D1351 |
Sealant - per tooth |
862 |
150 |
$20K |
| D1206 |
Topical application of fluoride varnish |
1,204 |
831 |
$18K |
| D0350 |
|
754 |
694 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
830 |
491 |
$8K |
| D1110 |
Prophylaxis - adult |
279 |
268 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
26 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
87 |
78 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
13 |
$79.02 |
| D1999 |
|
1,836 |
1,463 |
$0.00 |