| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1354 |
|
2,065 |
263 |
$156K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
907 |
514 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,195 |
667 |
$123K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
679 |
188 |
$83K |
| D1110 |
Prophylaxis - adult |
1,385 |
1,376 |
$59K |
| D0330 |
Panoramic radiographic image |
1,046 |
1,042 |
$49K |
| D1120 |
Prophylaxis - child |
1,579 |
1,569 |
$46K |
| D1206 |
Topical application of fluoride varnish |
2,766 |
2,750 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,959 |
1,953 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,615 |
2,584 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,164 |
1,162 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,145 |
1,132 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,650 |
2,048 |
$27K |
| D2394 |
|
119 |
84 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
278 |
170 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
434 |
432 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
79 |
$11K |
| D0350 |
|
290 |
289 |
$9K |
| D0272 |
Bitewings - two radiographic images |
420 |
418 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
260 |
253 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
29 |
28 |
$2K |
| D2332 |
|
19 |
12 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
14 |
12 |
$1K |