| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,168 |
2,303 |
$517K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,562 |
1,309 |
$197K |
| D0120 |
Periodic oral evaluation - established patient |
6,408 |
6,117 |
$157K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,148 |
673 |
$138K |
| D1110 |
Prophylaxis - adult |
3,582 |
3,423 |
$129K |
| D0330 |
Panoramic radiographic image |
3,107 |
2,829 |
$124K |
| D0274 |
Bitewings - four radiographic images |
4,213 |
3,897 |
$114K |
| D0220 |
Intraoral - periapical first radiographic image |
7,419 |
6,790 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,731 |
2,509 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,761 |
5,804 |
$94K |
| D1120 |
Prophylaxis - child |
3,086 |
2,955 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
1,976 |
1,795 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,498 |
3,351 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,312 |
1,215 |
$56K |
| D1351 |
Sealant - per tooth |
1,045 |
218 |
$28K |
| D0272 |
Bitewings - two radiographic images |
1,281 |
1,231 |
$22K |
| D1206 |
Topical application of fluoride varnish |
907 |
861 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
161 |
81 |
$9K |
| D4355 |
|
94 |
89 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
12 |
$3K |
| D2332 |
|
25 |
13 |
$2K |
| D4346 |
|
26 |
26 |
$1K |
| D1999 |
|
13 |
13 |
$0.00 |