| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,945 |
3,742 |
$631K |
| D1110 |
Prophylaxis - adult |
8,174 |
7,923 |
$339K |
| D8670 |
Periodic orthodontic treatment visit |
779 |
767 |
$317K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,670 |
2,082 |
$239K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,137 |
1,316 |
$214K |
| D0120 |
Periodic oral evaluation - established patient |
8,384 |
8,266 |
$153K |
| D0330 |
Panoramic radiographic image |
4,614 |
2,978 |
$147K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,419 |
7,341 |
$146K |
| D0274 |
Bitewings - four radiographic images |
6,033 |
5,895 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,164 |
4,509 |
$129K |
| D9630 |
|
6,764 |
6,412 |
$121K |
| D1120 |
Prophylaxis - child |
3,665 |
3,645 |
$118K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,283 |
643 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
2,584 |
1,982 |
$71K |
| D0140 |
Limited oral evaluation - problem focused |
2,877 |
1,955 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
557 |
213 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
4,985 |
3,387 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,719 |
1,179 |
$17K |
| D8660 |
|
64 |
64 |
$11K |
| D2950 |
|
72 |
68 |
$7K |
| D2394 |
|
44 |
33 |
$6K |
| D4910 |
|
92 |
88 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
149 |
129 |
$4K |
| D0272 |
Bitewings - two radiographic images |
207 |
195 |
$4K |
| D0340 |
|
38 |
38 |
$3K |
| D4341 |
|
61 |
24 |
$3K |
| D2332 |
|
15 |
12 |
$2K |
| D1354 |
|
69 |
26 |
$2K |
| D2330 |
|
23 |
13 |
$965.60 |
| D9994 |
|
869 |
869 |
$0.00 |
| D3120 |
|
143 |
91 |
$0.00 |