| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,675 |
1,295 |
$274K |
| D1110 |
Prophylaxis - adult |
3,657 |
3,505 |
$136K |
| D0120 |
Periodic oral evaluation - established patient |
5,197 |
4,975 |
$128K |
| D0274 |
Bitewings - four radiographic images |
2,730 |
2,605 |
$83K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,900 |
1,789 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
5,203 |
4,908 |
$76K |
| D1120 |
Prophylaxis - child |
2,707 |
2,596 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,067 |
4,097 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
850 |
453 |
$64K |
| D0330 |
Panoramic radiographic image |
903 |
862 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
396 |
229 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,729 |
2,621 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,183 |
1,089 |
$41K |
| D7140 |
Extraction, erupted tooth or exposed root |
610 |
311 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,320 |
1,263 |
$21K |
| D0272 |
Bitewings - two radiographic images |
825 |
800 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
336 |
308 |
$15K |
| D4341 |
|
32 |
12 |
$2K |