| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,104 |
2,543 |
$298K |
| D1110 |
Prophylaxis - adult |
5,895 |
5,790 |
$247K |
| D1208 |
Topical application of fluoride, excluding varnish |
11,252 |
11,044 |
$228K |
| D0120 |
Periodic oral evaluation - established patient |
9,103 |
8,935 |
$213K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,588 |
1,416 |
$183K |
| D1120 |
Prophylaxis - child |
5,563 |
5,456 |
$182K |
| D0210 |
Intraoral - complete series of radiographic images |
2,132 |
2,096 |
$126K |
| D0274 |
Bitewings - four radiographic images |
2,611 |
2,564 |
$70K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,321 |
2,274 |
$65K |
| D1351 |
Sealant - per tooth |
2,143 |
841 |
$62K |
| D0272 |
Bitewings - two radiographic images |
2,358 |
2,309 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
1,950 |
1,887 |
$23K |
| D0330 |
Panoramic radiographic image |
383 |
375 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
255 |
164 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
348 |
336 |
$8K |
| D2332 |
|
51 |
26 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
42 |
24 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
264 |
140 |
$2K |
| D2330 |
|
12 |
12 |
$718.85 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
20 |
20 |
$561.26 |