| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,697 |
4,572 |
$1.03M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
7,557 |
3,195 |
$603K |
| D0120 |
Periodic oral evaluation - established patient |
8,679 |
8,452 |
$225K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,416 |
1,063 |
$185K |
| D1120 |
Prophylaxis - child |
5,742 |
5,646 |
$159K |
| D1110 |
Prophylaxis - adult |
4,069 |
3,923 |
$154K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,358 |
7,181 |
$123K |
| D1351 |
Sealant - per tooth |
3,754 |
1,446 |
$109K |
| D0240 |
|
3,478 |
3,273 |
$107K |
| D0330 |
Panoramic radiographic image |
1,534 |
1,483 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,437 |
2,325 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,301 |
1,245 |
$56K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,056 |
927 |
$47K |
| D0272 |
Bitewings - two radiographic images |
2,332 |
2,291 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,536 |
2,436 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
980 |
924 |
$35K |
| D7140 |
Extraction, erupted tooth or exposed root |
470 |
268 |
$29K |
| D2330 |
|
418 |
237 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,042 |
1,747 |
$24K |
| D1206 |
Topical application of fluoride varnish |
1,390 |
1,379 |
$23K |
| D9110 |
|
197 |
194 |
$9K |
| D2331 |
|
16 |
12 |
$1K |
| D4355 |
|
12 |
12 |
$805.28 |