| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,363 |
1,647 |
$165K |
| D1120 |
Prophylaxis - child |
14,206 |
10,478 |
$158K |
| D0330 |
Panoramic radiographic image |
6,942 |
5,107 |
$115K |
| D1206 |
Topical application of fluoride varnish |
12,524 |
9,135 |
$107K |
| D1351 |
Sealant - per tooth |
16,015 |
1,924 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
9,552 |
6,146 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
4,102 |
3,603 |
$70K |
| D0140 |
Limited oral evaluation - problem focused |
3,065 |
2,314 |
$56K |
| D0274 |
Bitewings - four radiographic images |
5,446 |
3,910 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
956 |
507 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
2,952 |
1,771 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
3,179 |
2,396 |
$15K |
| D0272 |
Bitewings - two radiographic images |
4,490 |
2,930 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
146 |
91 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
916 |
540 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
187 |
105 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
91 |
37 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,216 |
380 |
$2K |
| D1110 |
Prophylaxis - adult |
84 |
45 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
25 |
$39.16 |