| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,198 |
1,623 |
$312K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,101 |
1,067 |
$244K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,408 |
934 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,481 |
3,053 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,479 |
421 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,583 |
3,308 |
$86K |
| D0274 |
Bitewings - four radiographic images |
2,600 |
2,289 |
$71K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,713 |
3,765 |
$71K |
| D4355 |
|
1,164 |
1,009 |
$69K |
| D1120 |
Prophylaxis - child |
2,558 |
2,370 |
$66K |
| D0220 |
Intraoral - periapical first radiographic image |
4,867 |
4,269 |
$65K |
| D1110 |
Prophylaxis - adult |
1,723 |
1,536 |
$58K |
| D1206 |
Topical application of fluoride varnish |
3,554 |
3,288 |
$54K |
| D0330 |
Panoramic radiographic image |
1,204 |
1,053 |
$52K |
| D2394 |
|
225 |
152 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
864 |
772 |
$29K |
| D0272 |
Bitewings - two radiographic images |
856 |
791 |
$15K |
| D2332 |
|
147 |
53 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
135 |
62 |
$13K |
| D2335 |
|
24 |
13 |
$3K |
| D1351 |
Sealant - per tooth |
121 |
26 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
64 |
49 |
$3K |