| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,787 |
1,882 |
$350K |
| D1351 |
Sealant - per tooth |
11,692 |
2,791 |
$313K |
| D1110 |
Prophylaxis - adult |
5,715 |
5,629 |
$302K |
| D0120 |
Periodic oral evaluation - established patient |
7,687 |
7,592 |
$213K |
| D0274 |
Bitewings - four radiographic images |
5,996 |
5,917 |
$195K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,157 |
8,159 |
$145K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,672 |
8,555 |
$124K |
| D0145 |
Oral evaluation for a patient under three years of age |
860 |
850 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,616 |
967 |
$115K |
| D1120 |
Prophylaxis - child |
3,192 |
3,163 |
$113K |
| D7240 |
Removal of impacted tooth - completely bony |
402 |
130 |
$109K |
| D0220 |
Intraoral - periapical first radiographic image |
8,705 |
8,568 |
$104K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,201 |
1,153 |
$40K |
| D0272 |
Bitewings - two radiographic images |
1,707 |
1,694 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
295 |
287 |
$18K |
| D9243 |
|
439 |
180 |
$16K |
| D9239 |
|
185 |
183 |
$10K |
| D0330 |
Panoramic radiographic image |
325 |
320 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
273 |
263 |
$7K |
| D1352 |
|
112 |
24 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
159 |
157 |
$4K |
| D1206 |
Topical application of fluoride varnish |
170 |
166 |
$2K |
| D9612 |
|
28 |
28 |
$895.75 |
| D4910 |
|
15 |
13 |
$749.25 |
| D0270 |
|
12 |
12 |
$77.21 |
| D0603 |
|
10,253 |
10,132 |
$0.01 |