| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,834 |
882 |
$196K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,326 |
675 |
$174K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,111 |
393 |
$91K |
| D2394 |
|
536 |
218 |
$87K |
| D1110 |
Prophylaxis - adult |
2,278 |
2,207 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
3,079 |
2,996 |
$77K |
| D0274 |
Bitewings - four radiographic images |
1,316 |
1,277 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,235 |
2,181 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,694 |
1,657 |
$32K |
| D1120 |
Prophylaxis - child |
1,091 |
1,066 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
1,980 |
1,906 |
$29K |
| D0330 |
Panoramic radiographic image |
561 |
541 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
685 |
655 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
190 |
182 |
$8K |
| D1206 |
Topical application of fluoride varnish |
426 |
417 |
$7K |
| D2330 |
|
87 |
38 |
$6K |
| D0272 |
Bitewings - two radiographic images |
305 |
296 |
$5K |
| D9110 |
|
80 |
74 |
$3K |
| D4355 |
|
48 |
47 |
$3K |
| D1351 |
Sealant - per tooth |
44 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
13 |
$817.96 |
| D2940 |
|
19 |
13 |
$734.44 |