| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,315 |
1,808 |
$328K |
| D1120 |
Prophylaxis - child |
8,914 |
8,811 |
$266K |
| D0120 |
Periodic oral evaluation - established patient |
11,787 |
11,628 |
$246K |
| D1110 |
Prophylaxis - adult |
4,670 |
4,601 |
$211K |
| D1206 |
Topical application of fluoride varnish |
11,273 |
11,098 |
$181K |
| D0330 |
Panoramic radiographic image |
2,972 |
2,928 |
$144K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
630 |
371 |
$96K |
| D0274 |
Bitewings - four radiographic images |
2,993 |
2,929 |
$91K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,355 |
2,817 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,354 |
873 |
$80K |
| D0272 |
Bitewings - two radiographic images |
3,505 |
3,480 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,737 |
1,683 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,635 |
1,608 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,114 |
2,977 |
$48K |
| D2394 |
|
189 |
113 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,239 |
2,239 |
$32K |
| D0602 |
|
3,101 |
3,045 |
$28K |
| D0603 |
|
2,866 |
2,820 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
249 |
178 |
$16K |
| D1351 |
Sealant - per tooth |
549 |
146 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
93 |
26 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,280 |
821 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
88 |
88 |
$3K |
| D0601 |
|
112 |
112 |
$978.73 |
| D3120 |
|
19 |
12 |
$548.82 |