| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,573 |
2,195 |
$463K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,375 |
1,233 |
$269K |
| D1110 |
Prophylaxis - adult |
3,828 |
3,732 |
$194K |
| D0330 |
Panoramic radiographic image |
3,259 |
3,163 |
$190K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,992 |
3,375 |
$143K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,075 |
2,959 |
$133K |
| D2931 |
|
936 |
453 |
$124K |
| D1120 |
Prophylaxis - child |
3,216 |
3,103 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
3,818 |
3,731 |
$115K |
| D0272 |
Bitewings - two radiographic images |
4,330 |
4,190 |
$97K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,729 |
3,617 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
3,101 |
2,973 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
599 |
362 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,284 |
2,053 |
$31K |
| D2950 |
|
337 |
171 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,032 |
992 |
$24K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
98 |
41 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
967 |
924 |
$13K |
| D7111 |
|
220 |
110 |
$13K |
| D2394 |
|
99 |
63 |
$10K |
| D1351 |
Sealant - per tooth |
208 |
65 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
31 |
12 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
25 |
25 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$722.04 |