| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,088 |
960 |
$138K |
| D1110 |
Prophylaxis - adult |
2,123 |
2,025 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,490 |
741 |
$83K |
| D1206 |
Topical application of fluoride varnish |
3,491 |
3,354 |
$69K |
| D1120 |
Prophylaxis - child |
2,281 |
2,203 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,315 |
2,240 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,212 |
2,115 |
$52K |
| D0330 |
Panoramic radiographic image |
1,196 |
1,122 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,361 |
1,297 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,038 |
1,871 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,327 |
1,548 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
363 |
344 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
180 |
103 |
$13K |
| D1351 |
Sealant - per tooth |
638 |
148 |
$12K |
| D1354 |
|
941 |
206 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
355 |
305 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
150 |
65 |
$6K |
| D2332 |
|
78 |
40 |
$6K |
| D0272 |
Bitewings - two radiographic images |
329 |
315 |
$5K |
| D9110 |
|
137 |
112 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
154 |
154 |
$3K |
| D2335 |
|
27 |
17 |
$2K |
| D2330 |
|
34 |
13 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
31 |
30 |
$906.75 |