| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,236 |
2,089 |
$315K |
| D8670 |
Periodic orthodontic treatment visit |
2,674 |
2,261 |
$244K |
| D1120 |
Prophylaxis - child |
9,872 |
8,241 |
$217K |
| D0120 |
Periodic oral evaluation - established patient |
6,859 |
6,191 |
$167K |
| D1206 |
Topical application of fluoride varnish |
9,161 |
7,678 |
$161K |
| D0330 |
Panoramic radiographic image |
3,625 |
2,920 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,638 |
909 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,250 |
2,810 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,837 |
1,509 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,855 |
1,897 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,011 |
2,449 |
$27K |
| D0272 |
Bitewings - two radiographic images |
1,970 |
1,551 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
502 |
234 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
654 |
419 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
351 |
123 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
775 |
616 |
$8K |
| D1351 |
Sealant - per tooth |
301 |
51 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
227 |
170 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
163 |
161 |
$3K |
| D1110 |
Prophylaxis - adult |
78 |
76 |
$2K |
| D0350 |
|
32 |
28 |
$407.40 |
| D9986 |
|
546 |
480 |
$0.00 |
| D0340 |
|
18 |
15 |
$0.00 |