| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,472 |
829 |
$146K |
| D1110 |
Prophylaxis - adult |
2,740 |
2,601 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
3,438 |
3,283 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
2,175 |
2,012 |
$75K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
499 |
304 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
790 |
473 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,408 |
1,290 |
$54K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,062 |
2,890 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
3,273 |
3,041 |
$47K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,302 |
1,703 |
$37K |
| D0274 |
Bitewings - four radiographic images |
1,236 |
1,158 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
348 |
124 |
$32K |
| D1120 |
Prophylaxis - child |
1,250 |
1,176 |
$29K |
| D0330 |
Panoramic radiographic image |
462 |
431 |
$20K |
| D2950 |
|
204 |
159 |
$20K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
33 |
27 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
164 |
150 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
178 |
148 |
$7K |
| D0272 |
Bitewings - two radiographic images |
274 |
256 |
$4K |
| D2332 |
|
21 |
14 |
$2K |
| D4355 |
|
29 |
29 |
$2K |
| D0240 |
|
23 |
12 |
$349.37 |