| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,512 |
3,658 |
$1.45M |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,422 |
2,726 |
$779K |
| D0120 |
Periodic oral evaluation - established patient |
13,022 |
12,584 |
$523K |
| D1110 |
Prophylaxis - adult |
7,379 |
7,223 |
$498K |
| D1120 |
Prophylaxis - child |
7,236 |
7,086 |
$378K |
| D1206 |
Topical application of fluoride varnish |
11,103 |
10,895 |
$360K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,268 |
904 |
$332K |
| D1351 |
Sealant - per tooth |
7,164 |
1,357 |
$316K |
| D0274 |
Bitewings - four radiographic images |
5,619 |
5,481 |
$281K |
| D0330 |
Panoramic radiographic image |
2,121 |
2,047 |
$162K |
| D0220 |
Intraoral - periapical first radiographic image |
4,233 |
4,041 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,775 |
1,549 |
$79K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,821 |
3,269 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
977 |
864 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,844 |
1,801 |
$57K |
| D0272 |
Bitewings - two radiographic images |
1,257 |
1,215 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
81 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
303 |
292 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
349 |
341 |
$8K |
| D2332 |
|
19 |
13 |
$4K |
| D2331 |
|
13 |
12 |
$2K |
| D0240 |
|
19 |
12 |
$355.63 |
| D0602 |
|
12,195 |
11,859 |
$0.00 |
| D0603 |
|
1,471 |
1,409 |
$0.00 |
| D0601 |
|
42 |
40 |
$0.00 |