| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
776 |
401 |
$80K |
| D1120 |
Prophylaxis - child |
2,510 |
2,404 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,363 |
1,285 |
$54K |
| D1206 |
Topical application of fluoride varnish |
2,185 |
2,126 |
$45K |
| D0330 |
Panoramic radiographic image |
793 |
770 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,206 |
1,171 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
281 |
175 |
$22K |
| D0274 |
Bitewings - four radiographic images |
710 |
686 |
$20K |
| D8670 |
Periodic orthodontic treatment visit |
225 |
172 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
206 |
110 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
98 |
62 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
286 |
270 |
$11K |
| D0272 |
Bitewings - two radiographic images |
425 |
416 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
88 |
88 |
$6K |
| D1351 |
Sealant - per tooth |
209 |
40 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
431 |
397 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
123 |
107 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
191 |
170 |
$3K |
| D0340 |
|
20 |
19 |
$987.18 |
| D0230 |
Intraoral - periapical each additional radiographic image |
105 |
61 |
$710.40 |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$697.00 |
| D0350 |
|
19 |
18 |
$488.18 |