| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,136 |
2,127 |
$292K |
| D1120 |
Prophylaxis - child |
8,651 |
8,480 |
$215K |
| D0120 |
Periodic oral evaluation - established patient |
11,380 |
11,084 |
$195K |
| D1206 |
Topical application of fluoride varnish |
11,411 |
11,106 |
$165K |
| D1110 |
Prophylaxis - adult |
3,757 |
3,609 |
$125K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,227 |
1,470 |
$113K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,395 |
3,769 |
$87K |
| D0272 |
Bitewings - two radiographic images |
3,453 |
3,364 |
$53K |
| D1351 |
Sealant - per tooth |
2,229 |
790 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,443 |
1,392 |
$33K |
| D2330 |
|
269 |
155 |
$13K |
| D0330 |
Panoramic radiographic image |
239 |
236 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
126 |
84 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
352 |
347 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
133 |
129 |
$6K |
| D0240 |
|
431 |
301 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
37 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
351 |
327 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
112 |
110 |
$2K |
| D1354 |
|
543 |
152 |
$2K |
| D9410 |
|
104 |
95 |
$2K |
| D9420 |
|
25 |
24 |
$609.89 |
| D0140 |
Limited oral evaluation - problem focused |
16 |
16 |
$422.25 |