| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,070 |
1,310 |
$222K |
| D1110 |
Prophylaxis - adult |
4,963 |
4,868 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
6,219 |
6,126 |
$157K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
786 |
550 |
$100K |
| D0274 |
Bitewings - four radiographic images |
2,301 |
2,254 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,660 |
3,621 |
$62K |
| D1120 |
Prophylaxis - child |
2,066 |
2,039 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
2,712 |
2,610 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
819 |
796 |
$35K |
| D0330 |
Panoramic radiographic image |
650 |
625 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
870 |
834 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
272 |
187 |
$21K |
| D0272 |
Bitewings - two radiographic images |
642 |
629 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
785 |
416 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
145 |
135 |
$7K |
| D2394 |
|
19 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
108 |
30 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
28 |
14 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
40 |
39 |
$2K |
| D2332 |
|
17 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$211.32 |