| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,742 |
1,201 |
$134K |
| D1206 |
Topical application of fluoride varnish |
3,438 |
3,430 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
2,917 |
2,910 |
$73K |
| D1110 |
Prophylaxis - adult |
1,533 |
1,527 |
$66K |
| D1120 |
Prophylaxis - child |
1,853 |
1,852 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
967 |
738 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
644 |
477 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,786 |
1,730 |
$54K |
| D0210 |
Intraoral - complete series of radiographic images |
742 |
740 |
$44K |
| D1351 |
Sealant - per tooth |
1,254 |
474 |
$42K |
| D0274 |
Bitewings - four radiographic images |
836 |
833 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,476 |
1,464 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
559 |
558 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,284 |
1,265 |
$11K |
| D2332 |
|
77 |
45 |
$7K |
| D0272 |
Bitewings - two radiographic images |
362 |
362 |
$6K |
| D4346 |
|
126 |
126 |
$6K |
| D2991 |
|
195 |
35 |
$5K |
| D0330 |
Panoramic radiographic image |
98 |
98 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
53 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
102 |
101 |
$2K |
| D2330 |
|
15 |
14 |
$999.30 |