| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,362 |
2,604 |
$284K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
509 |
417 |
$242K |
| D0120 |
Periodic oral evaluation - established patient |
3,830 |
3,819 |
$217K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,289 |
1,969 |
$174K |
| D1120 |
Prophylaxis - child |
3,824 |
3,811 |
$149K |
| D0230 |
Intraoral - periapical each additional radiographic image |
29,462 |
5,673 |
$121K |
| D4910 |
|
1,424 |
1,418 |
$108K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,546 |
1,546 |
$95K |
| D0350 |
|
7,350 |
3,129 |
$72K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
885 |
681 |
$69K |
| D9430 |
|
2,129 |
1,863 |
$67K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,585 |
1,378 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,574 |
4,560 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,097 |
2,091 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
853 |
853 |
$39K |
| D1110 |
Prophylaxis - adult |
426 |
424 |
$37K |
| D4341 |
|
529 |
151 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,751 |
1,749 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,527 |
1,457 |
$18K |
| D1351 |
Sealant - per tooth |
697 |
304 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
225 |
107 |
$13K |
| D2330 |
|
156 |
96 |
$12K |
| D1310 |
|
140 |
140 |
$6K |
| D7111 |
|
74 |
41 |
$4K |
| D9993 |
|
111 |
111 |
$4K |
| D0330 |
Panoramic radiographic image |
116 |
116 |
$3K |
| D0603 |
|
140 |
140 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
23 |
19 |
$54.72 |
| D0999 |
Unspecified diagnostic procedure, by report |
28 |
24 |
$0.00 |