| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,335 |
1,023 |
$97K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,294 |
859 |
$79K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,153 |
591 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
2,693 |
2,575 |
$46K |
| D4341 |
|
2,289 |
603 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,138 |
1,072 |
$28K |
| D1206 |
Topical application of fluoride varnish |
2,447 |
2,290 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,886 |
3,367 |
$21K |
| D1120 |
Prophylaxis - child |
1,093 |
1,062 |
$21K |
| D1110 |
Prophylaxis - adult |
655 |
616 |
$16K |
| D0274 |
Bitewings - four radiographic images |
2,070 |
1,951 |
$16K |
| D2332 |
|
303 |
157 |
$16K |
| D0330 |
Panoramic radiographic image |
745 |
713 |
$16K |
| D4910 |
|
934 |
857 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
783 |
717 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
818 |
786 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,687 |
2,772 |
$7K |
| D2330 |
|
179 |
96 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
338 |
274 |
$5K |
| D1999 |
|
847 |
742 |
$4K |
| D2331 |
|
73 |
48 |
$4K |
| D0272 |
Bitewings - two radiographic images |
339 |
331 |
$3K |
| D2335 |
|
26 |
15 |
$2K |
| D1351 |
Sealant - per tooth |
106 |
26 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
39 |
38 |
$937.72 |
| D2394 |
|
21 |
13 |
$789.48 |