| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,260 |
1,504 |
$350K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,492 |
794 |
$141K |
| D1110 |
Prophylaxis - adult |
2,050 |
2,017 |
$85K |
| D2332 |
|
976 |
503 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
2,547 |
2,490 |
$69K |
| D0274 |
Bitewings - four radiographic images |
1,842 |
1,815 |
$55K |
| D0220 |
Intraoral - periapical first radiographic image |
4,722 |
4,543 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
949 |
306 |
$47K |
| D1120 |
Prophylaxis - child |
1,861 |
1,810 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
933 |
912 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,033 |
3,910 |
$36K |
| D1206 |
Topical application of fluoride varnish |
2,614 |
2,543 |
$34K |
| D2394 |
|
317 |
169 |
$33K |
| D2335 |
|
404 |
172 |
$32K |
| D0272 |
Bitewings - two radiographic images |
1,759 |
1,713 |
$25K |
| D0330 |
Panoramic radiographic image |
671 |
662 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
330 |
318 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
265 |
236 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
111 |
65 |
$6K |
| 99213 |
Office or other outpatient visit for the evaluation and management of an established patient, low complexity |
29 |
25 |
$981.00 |
| D1351 |
Sealant - per tooth |
50 |
20 |
$950.00 |