| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,315 |
1,599 |
$239K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,711 |
4,695 |
$163K |
| D1120 |
Prophylaxis - child |
5,141 |
5,129 |
$160K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,075 |
6,061 |
$109K |
| D0274 |
Bitewings - four radiographic images |
3,321 |
3,313 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
1,504 |
1,478 |
$85K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,164 |
685 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
5,253 |
5,218 |
$59K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,152 |
4,533 |
$55K |
| D1110 |
Prophylaxis - adult |
1,162 |
1,158 |
$53K |
| D0120 |
Periodic oral evaluation - established patient |
2,308 |
2,305 |
$52K |
| D7140 |
Extraction, erupted tooth or exposed root |
475 |
287 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
315 |
241 |
$27K |
| D1351 |
Sealant - per tooth |
1,064 |
260 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,126 |
1,125 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
563 |
558 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
489 |
465 |
$13K |
| D1206 |
Topical application of fluoride varnish |
667 |
664 |
$12K |
| D4346 |
|
70 |
70 |
$8K |
| D4341 |
|
32 |
13 |
$4K |
| D8660 |
|
15 |
15 |
$2K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$1K |
| D0270 |
|
54 |
54 |
$554.47 |
| D0603 |
|
37 |
37 |
$0.00 |
| D0602 |
|
16 |
16 |
$0.00 |