| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,710 |
956 |
$235K |
| D1110 |
Prophylaxis - adult |
2,392 |
2,083 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
4,301 |
3,740 |
$101K |
| D0274 |
Bitewings - four radiographic images |
3,692 |
3,192 |
$91K |
| D1120 |
Prophylaxis - child |
3,002 |
2,598 |
$87K |
| D1206 |
Topical application of fluoride varnish |
4,484 |
3,896 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
632 |
267 |
$43K |
| D1351 |
Sealant - per tooth |
1,813 |
342 |
$42K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,274 |
1,776 |
$39K |
| D0145 |
Oral evaluation for a patient under three years of age |
298 |
260 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
818 |
680 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
2,283 |
1,974 |
$20K |
| D0330 |
Panoramic radiographic image |
1,146 |
978 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
98 |
58 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
307 |
275 |
$7K |
| D0272 |
Bitewings - two radiographic images |
429 |
363 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
79 |
78 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
305 |
292 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
37 |
15 |
$827.78 |
| D0140 |
Limited oral evaluation - problem focused |
26 |
25 |
$431.94 |
| D0602 |
|
1,915 |
1,815 |
$0.00 |
| D0603 |
|
1,710 |
1,618 |
$0.00 |
| D0601 |
|
1,199 |
1,140 |
$0.00 |