| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,303 |
711 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
2,621 |
2,593 |
$49K |
| D1120 |
Prophylaxis - child |
2,252 |
2,231 |
$43K |
| D1110 |
Prophylaxis - adult |
1,021 |
1,007 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
713 |
446 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
782 |
775 |
$23K |
| D1206 |
Topical application of fluoride varnish |
2,978 |
2,949 |
$23K |
| D0330 |
Panoramic radiographic image |
445 |
433 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
152 |
98 |
$14K |
| D1351 |
Sealant - per tooth |
989 |
299 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,088 |
2,881 |
$7K |
| D0272 |
Bitewings - two radiographic images |
1,726 |
1,706 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
464 |
391 |
$7K |
| D1330 |
|
3,383 |
3,323 |
$7K |
| D0274 |
Bitewings - four radiographic images |
1,094 |
1,082 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
3,110 |
3,042 |
$5K |
| D7111 |
|
161 |
111 |
$4K |
| D9920 |
|
263 |
260 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
218 |
213 |
$2K |
| D3120 |
|
265 |
175 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
53 |
53 |
$1K |
| D0350 |
|
800 |
719 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
87 |
87 |
$16.42 |
| D8660 |
|
51 |
47 |
$0.00 |
| D9986 |
|
60 |
60 |
$0.00 |
| D1310 |
|
1,521 |
1,505 |
$0.00 |