| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,987 |
1,909 |
$365K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,362 |
1,292 |
$169K |
| D0120 |
Periodic oral evaluation - established patient |
5,505 |
5,373 |
$150K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,987 |
4,790 |
$142K |
| D1120 |
Prophylaxis - child |
3,690 |
3,610 |
$128K |
| D1110 |
Prophylaxis - adult |
2,351 |
2,277 |
$121K |
| D0274 |
Bitewings - four radiographic images |
2,855 |
2,778 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,408 |
5,271 |
$76K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
798 |
485 |
$75K |
| D0220 |
Intraoral - periapical first radiographic image |
5,225 |
5,075 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
666 |
638 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,268 |
1,068 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
418 |
400 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
94 |
90 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$350.30 |
| D0603 |
|
5,966 |
5,851 |
$0.00 |