| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,909 |
558 |
$109K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,476 |
451 |
$69K |
| D1351 |
Sealant - per tooth |
2,473 |
305 |
$58K |
| D1110 |
Prophylaxis - adult |
1,439 |
1,432 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,520 |
1,513 |
$41K |
| D9920 |
|
376 |
338 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
944 |
940 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
348 |
115 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
287 |
142 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
728 |
722 |
$16K |
| D0330 |
Panoramic radiographic image |
401 |
398 |
$14K |
| D2330 |
|
322 |
90 |
$14K |
| D1320 |
|
669 |
578 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,178 |
1,124 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
983 |
960 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
228 |
182 |
$8K |
| D1120 |
Prophylaxis - child |
212 |
210 |
$6K |
| D9110 |
|
179 |
174 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
307 |
307 |
$4K |
| D2332 |
|
66 |
28 |
$4K |
| D1206 |
Topical application of fluoride varnish |
161 |
158 |
$3K |
| D0602 |
|
227 |
227 |
$2K |
| D1330 |
|
433 |
432 |
$2K |
| D4341 |
|
29 |
12 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
29 |
$1K |
| D1310 |
|
46 |
46 |
$348.48 |
| D0603 |
|
12 |
12 |
$120.00 |
| D1999 |
|
16 |
15 |
$0.00 |