| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,951 |
2,554 |
$370K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,313 |
1,873 |
$219K |
| D1110 |
Prophylaxis - adult |
5,536 |
5,456 |
$202K |
| D0120 |
Periodic oral evaluation - established patient |
7,681 |
7,609 |
$179K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,736 |
8,593 |
$136K |
| D1120 |
Prophylaxis - child |
2,951 |
2,893 |
$65K |
| D0330 |
Panoramic radiographic image |
1,602 |
1,555 |
$56K |
| D0274 |
Bitewings - four radiographic images |
3,729 |
3,652 |
$52K |
| D1351 |
Sealant - per tooth |
1,378 |
364 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
607 |
566 |
$21K |
| D1999 |
|
1,547 |
1,241 |
$19K |
| D0272 |
Bitewings - two radiographic images |
1,325 |
1,298 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
662 |
614 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
63 |
41 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
175 |
169 |
$4K |
| D1206 |
Topical application of fluoride varnish |
195 |
194 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
94 |
70 |
$2K |
| D2331 |
|
26 |
13 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
14 |
$386.12 |
| D0230 |
Intraoral - periapical each additional radiographic image |
136 |
135 |
$326.22 |
| D1330 |
|
39 |
39 |
$0.00 |