| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,740 |
3,240 |
$1.21M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,440 |
1,996 |
$689K |
| D1351 |
Sealant - per tooth |
11,309 |
2,463 |
$501K |
| D1110 |
Prophylaxis - adult |
5,638 |
5,147 |
$297K |
| D1206 |
Topical application of fluoride varnish |
10,149 |
9,625 |
$289K |
| D0120 |
Periodic oral evaluation - established patient |
7,611 |
7,130 |
$270K |
| D1120 |
Prophylaxis - child |
4,907 |
4,794 |
$266K |
| D0274 |
Bitewings - four radiographic images |
7,549 |
6,727 |
$257K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,269 |
4,560 |
$225K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,398 |
868 |
$195K |
| D0330 |
Panoramic radiographic image |
3,623 |
3,210 |
$173K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,414 |
865 |
$162K |
| D0220 |
Intraoral - periapical first radiographic image |
7,365 |
6,747 |
$146K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,757 |
5,979 |
$112K |
| D2394 |
|
304 |
213 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
535 |
292 |
$59K |
| D2335 |
|
303 |
161 |
$48K |
| D2332 |
|
227 |
133 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,087 |
945 |
$40K |
| D4355 |
|
460 |
386 |
$31K |
| D0272 |
Bitewings - two radiographic images |
661 |
647 |
$24K |
| D9920 |
|
139 |
123 |
$20K |
| D7250 |
|
183 |
110 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$995.70 |
| D0603 |
|
2,418 |
2,215 |
$0.00 |
| D0601 |
|
5,439 |
5,249 |
$0.00 |
| D0602 |
|
468 |
441 |
$0.00 |
| D2331 |
|
14 |
12 |
$0.00 |