| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
9,253 |
2,600 |
$412K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,982 |
2,198 |
$219K |
| D0120 |
Periodic oral evaluation - established patient |
5,714 |
5,376 |
$120K |
| D1206 |
Topical application of fluoride varnish |
7,822 |
7,342 |
$113K |
| D1120 |
Prophylaxis - child |
5,474 |
5,168 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,998 |
2,786 |
$92K |
| D0330 |
Panoramic radiographic image |
2,504 |
2,309 |
$68K |
| D1110 |
Prophylaxis - adult |
1,984 |
1,872 |
$60K |
| D9999 |
Unspecified adjunctive procedure, by report |
1,618 |
1,528 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
4,981 |
4,545 |
$34K |
| D0274 |
Bitewings - four radiographic images |
2,591 |
2,381 |
$27K |
| D9920 |
|
1,052 |
945 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,298 |
1,156 |
$23K |
| D0272 |
Bitewings - two radiographic images |
2,578 |
2,426 |
$22K |
| D1999 |
|
3,450 |
2,649 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,145 |
880 |
$21K |
| D4346 |
|
404 |
357 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,705 |
3,896 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
144 |
121 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
210 |
135 |
$9K |
| D2330 |
|
168 |
121 |
$8K |
| D1351 |
Sealant - per tooth |
158 |
58 |
$3K |
| D2331 |
|
66 |
39 |
$3K |
| D9630 |
|
16 |
12 |
$388.20 |
| D0270 |
|
153 |
129 |
$383.76 |
| D9994 |
|
27 |
25 |
$0.00 |