| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,980 |
5,575 |
$718K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
11,995 |
11,783 |
$413K |
| D1120 |
Prophylaxis - child |
12,782 |
12,564 |
$395K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,774 |
2,601 |
$327K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,440 |
3,034 |
$295K |
| D0274 |
Bitewings - four radiographic images |
8,754 |
8,576 |
$239K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,656 |
11,449 |
$206K |
| D1110 |
Prophylaxis - adult |
3,577 |
3,501 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
6,691 |
6,574 |
$145K |
| D4346 |
|
982 |
954 |
$111K |
| D1206 |
Topical application of fluoride varnish |
5,900 |
5,793 |
$106K |
| D0210 |
Intraoral - complete series of radiographic images |
1,531 |
1,490 |
$89K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,856 |
2,648 |
$76K |
| D0330 |
Panoramic radiographic image |
1,666 |
1,624 |
$67K |
| D1351 |
Sealant - per tooth |
2,075 |
544 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,383 |
1,613 |
$48K |
| D7140 |
Extraction, erupted tooth or exposed root |
629 |
322 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,552 |
3,438 |
$39K |
| D2330 |
|
469 |
261 |
$30K |
| D2394 |
|
229 |
190 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
315 |
300 |
$9K |
| D0272 |
Bitewings - two radiographic images |
328 |
320 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
42 |
25 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
15 |
$3K |
| D0270 |
|
13 |
12 |
$128.64 |