| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,813 |
1,822 |
$271K |
| D1110 |
Prophylaxis - adult |
3,538 |
3,537 |
$176K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,022 |
788 |
$117K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,486 |
1,118 |
$116K |
| D0274 |
Bitewings - four radiographic images |
4,127 |
4,126 |
$114K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
681 |
505 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
6,756 |
6,293 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
3,692 |
3,691 |
$85K |
| D7140 |
Extraction, erupted tooth or exposed root |
850 |
427 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,924 |
1,924 |
$77K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,271 |
4,270 |
$70K |
| D1120 |
Prophylaxis - child |
1,653 |
1,653 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,487 |
1,455 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,617 |
4,253 |
$44K |
| D0272 |
Bitewings - two radiographic images |
1,241 |
1,241 |
$24K |
| D0330 |
Panoramic radiographic image |
475 |
475 |
$23K |
| D1351 |
Sealant - per tooth |
203 |
68 |
$6K |
| D2335 |
|
43 |
24 |
$5K |
| D2394 |
|
13 |
12 |
$2K |
| D2332 |
|
14 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
18 |
$812.50 |