| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,139 |
3,411 |
$379K |
| D1110 |
Prophylaxis - adult |
4,779 |
4,524 |
$208K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,495 |
1,664 |
$202K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,727 |
1,728 |
$130K |
| D0274 |
Bitewings - four radiographic images |
4,109 |
3,873 |
$124K |
| D0120 |
Periodic oral evaluation - established patient |
5,641 |
5,337 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,077 |
2,901 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
2,384 |
2,159 |
$85K |
| D0140 |
Limited oral evaluation - problem focused |
1,891 |
1,778 |
$69K |
| D1120 |
Prophylaxis - child |
2,549 |
2,410 |
$68K |
| D1206 |
Topical application of fluoride varnish |
3,292 |
3,123 |
$63K |
| D0330 |
Panoramic radiographic image |
1,776 |
1,641 |
$63K |
| D2394 |
|
516 |
383 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,055 |
915 |
$28K |
| D4355 |
|
257 |
246 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,950 |
1,817 |
$21K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,084 |
1,020 |
$14K |
| D0272 |
Bitewings - two radiographic images |
709 |
671 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
20 |
13 |
$3K |
| D4342 |
|
39 |
12 |
$2K |
| D1351 |
Sealant - per tooth |
71 |
14 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$1K |
| D4910 |
|
14 |
14 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16 |
12 |
$167.00 |