| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,569 |
1,125 |
$251K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
796 |
421 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,198 |
1,979 |
$87K |
| D0330 |
Panoramic radiographic image |
1,875 |
1,680 |
$70K |
| D1110 |
Prophylaxis - adult |
1,991 |
1,838 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,489 |
2,268 |
$66K |
| D0120 |
Periodic oral evaluation - established patient |
2,672 |
2,467 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,706 |
3,130 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
3,920 |
3,520 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
462 |
252 |
$33K |
| D1120 |
Prophylaxis - child |
1,353 |
1,226 |
$33K |
| D1206 |
Topical application of fluoride varnish |
2,146 |
1,962 |
$31K |
| D4355 |
|
306 |
276 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
415 |
375 |
$13K |
| D0272 |
Bitewings - two radiographic images |
346 |
307 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
327 |
295 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
115 |
104 |
$5K |
| D1351 |
Sealant - per tooth |
51 |
14 |
$1K |
| D4346 |
|
13 |
13 |
$517.79 |
| D1999 |
|
160 |
127 |
$0.00 |