| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,182 |
1,763 |
$361K |
| D1110 |
Prophylaxis - adult |
5,931 |
5,737 |
$295K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,013 |
1,515 |
$274K |
| D1351 |
Sealant - per tooth |
7,901 |
1,487 |
$267K |
| D0120 |
Periodic oral evaluation - established patient |
7,558 |
7,360 |
$192K |
| D1206 |
Topical application of fluoride varnish |
6,534 |
6,432 |
$161K |
| D1120 |
Prophylaxis - child |
3,280 |
3,224 |
$141K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
824 |
593 |
$101K |
| D0274 |
Bitewings - four radiographic images |
4,324 |
4,163 |
$91K |
| D0330 |
Panoramic radiographic image |
2,133 |
2,070 |
$89K |
| D0140 |
Limited oral evaluation - problem focused |
1,852 |
1,716 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
6,177 |
5,888 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,705 |
5,207 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,035 |
986 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
201 |
110 |
$20K |
| D3120 |
|
582 |
327 |
$20K |
| D1330 |
|
3,123 |
3,061 |
$19K |
| D9944 |
|
48 |
48 |
$7K |
| D0272 |
Bitewings - two radiographic images |
428 |
423 |
$6K |
| D2332 |
|
30 |
12 |
$3K |
| D4341 |
|
37 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
53 |
51 |
$961.94 |
| D1999 |
|
30 |
27 |
$0.00 |