| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,856 |
1,608 |
$208K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,137 |
1,284 |
$128K |
| D1120 |
Prophylaxis - child |
2,870 |
2,784 |
$118K |
| D0330 |
Panoramic radiographic image |
2,767 |
2,619 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,926 |
3,744 |
$84K |
| D1110 |
Prophylaxis - adult |
2,116 |
1,995 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,838 |
757 |
$73K |
| D0274 |
Bitewings - four radiographic images |
2,754 |
2,631 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,742 |
3,614 |
$50K |
| D2394 |
|
523 |
331 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,409 |
1,356 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
679 |
566 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
555 |
255 |
$21K |
| D2335 |
|
205 |
102 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
522 |
500 |
$14K |
| D0272 |
Bitewings - two radiographic images |
275 |
267 |
$4K |
| D9110 |
|
191 |
182 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
48 |
25 |
$3K |
| D2331 |
|
25 |
14 |
$1K |
| D2332 |
|
19 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
109 |
106 |
$851.04 |
| D1206 |
Topical application of fluoride varnish |
34 |
31 |
$487.50 |
| D3110 |
|
22 |
16 |
$331.50 |