| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,239 |
3,065 |
$444K |
| D0120 |
Periodic oral evaluation - established patient |
14,981 |
14,603 |
$383K |
| D1120 |
Prophylaxis - child |
10,167 |
9,900 |
$275K |
| D1110 |
Prophylaxis - adult |
6,412 |
6,222 |
$224K |
| D1206 |
Topical application of fluoride varnish |
13,687 |
13,319 |
$218K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,839 |
1,427 |
$145K |
| D0220 |
Intraoral - periapical first radiographic image |
9,084 |
8,697 |
$133K |
| D1351 |
Sealant - per tooth |
5,608 |
1,583 |
$132K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,754 |
7,425 |
$103K |
| D0274 |
Bitewings - four radiographic images |
3,165 |
3,076 |
$97K |
| D0272 |
Bitewings - two radiographic images |
3,655 |
3,573 |
$65K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,017 |
577 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
937 |
904 |
$40K |
| D0330 |
Panoramic radiographic image |
723 |
701 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
807 |
771 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
101 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
101 |
98 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
28 |
27 |
$829.20 |
| D1354 |
|
28 |
13 |
$143.00 |
| D0191 |
|
94 |
93 |
$0.00 |