| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,712 |
1,706 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
702 |
395 |
$51K |
| D1120 |
Prophylaxis - child |
1,357 |
1,348 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,345 |
1,336 |
$39K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
668 |
355 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,970 |
1,959 |
$35K |
| D1110 |
Prophylaxis - adult |
474 |
471 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
224 |
110 |
$15K |
| D0330 |
Panoramic radiographic image |
323 |
320 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,144 |
1,123 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
441 |
433 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
289 |
279 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
551 |
542 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
68 |
24 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
60 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
671 |
611 |
$6K |
| D4346 |
|
30 |
30 |
$4K |
| D0272 |
Bitewings - two radiographic images |
133 |
132 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
75 |
74 |
$2K |
| D1351 |
Sealant - per tooth |
54 |
15 |
$1K |
| D0270 |
|
26 |
25 |
$246.35 |