| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,028 |
594 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
820 |
470 |
$40K |
| D1110 |
Prophylaxis - adult |
1,294 |
1,163 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
2,254 |
2,074 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,651 |
2,410 |
$34K |
| D1120 |
Prophylaxis - child |
1,371 |
1,264 |
$34K |
| D0330 |
Panoramic radiographic image |
724 |
615 |
$26K |
| D0274 |
Bitewings - four radiographic images |
1,069 |
955 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,087 |
1,000 |
$16K |
| D1351 |
Sealant - per tooth |
671 |
143 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
583 |
447 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
462 |
390 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
122 |
74 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
451 |
379 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
800 |
663 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
90 |
54 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
167 |
74 |
$626.00 |
| D0270 |
|
16 |
12 |
$0.00 |