| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,477 |
2,358 |
$341K |
| D1110 |
Prophylaxis - adult |
8,443 |
8,198 |
$283K |
| D0120 |
Periodic oral evaluation - established patient |
10,090 |
9,784 |
$231K |
| D0330 |
Panoramic radiographic image |
3,273 |
3,176 |
$162K |
| D4355 |
|
2,001 |
1,942 |
$125K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,730 |
7,519 |
$124K |
| D0274 |
Bitewings - four radiographic images |
3,992 |
3,854 |
$116K |
| D1120 |
Prophylaxis - child |
4,383 |
4,280 |
$113K |
| D0220 |
Intraoral - periapical first radiographic image |
8,434 |
8,079 |
$112K |
| D0140 |
Limited oral evaluation - problem focused |
3,386 |
3,269 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,607 |
2,516 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,290 |
870 |
$95K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
776 |
603 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,270 |
5,930 |
$86K |
| D7140 |
Extraction, erupted tooth or exposed root |
929 |
402 |
$47K |
| D1351 |
Sealant - per tooth |
1,620 |
562 |
$45K |
| D0272 |
Bitewings - two radiographic images |
1,825 |
1,783 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
200 |
120 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
311 |
293 |
$14K |
| D1206 |
Topical application of fluoride varnish |
423 |
418 |
$7K |