| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,041 |
1,153 |
$201K |
| D1110 |
Prophylaxis - adult |
2,086 |
2,057 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
3,868 |
3,796 |
$81K |
| D1120 |
Prophylaxis - child |
2,643 |
2,576 |
$80K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
567 |
122 |
$67K |
| D0330 |
Panoramic radiographic image |
1,268 |
1,244 |
$61K |
| D0274 |
Bitewings - four radiographic images |
1,351 |
1,326 |
$41K |
| D1206 |
Topical application of fluoride varnish |
2,330 |
2,245 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,337 |
2,294 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,982 |
1,982 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
982 |
894 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,363 |
1,854 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
835 |
820 |
$25K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
163 |
117 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,128 |
1,102 |
$20K |
| D5130 |
|
16 |
16 |
$13K |
| D5140 |
|
14 |
14 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
326 |
315 |
$10K |
| D1320 |
|
71 |
69 |
$2K |
| D1351 |
Sealant - per tooth |
59 |
16 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
14 |
$1K |