| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,301 |
621 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
2,888 |
2,817 |
$75K |
| D1110 |
Prophylaxis - adult |
1,819 |
1,770 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,075 |
2,977 |
$51K |
| D1120 |
Prophylaxis - child |
1,693 |
1,636 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
2,392 |
2,251 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,453 |
1,660 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
581 |
553 |
$25K |
| D0330 |
Panoramic radiographic image |
380 |
376 |
$23K |
| D0274 |
Bitewings - four radiographic images |
413 |
400 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
87 |
52 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
271 |
254 |
$10K |
| D0272 |
Bitewings - two radiographic images |
526 |
512 |
$10K |
| D1351 |
Sealant - per tooth |
156 |
49 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
52 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
53 |
26 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
31 |
14 |
$2K |
| D1206 |
Topical application of fluoride varnish |
36 |
36 |
$633.96 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
15 |
$612.75 |
| D1999 |
|
16 |
15 |
$0.00 |