| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,560 |
1,284 |
$186K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,126 |
1,108 |
$134K |
| D1110 |
Prophylaxis - adult |
2,997 |
2,688 |
$96K |
| D7240 |
Removal of impacted tooth - completely bony |
442 |
112 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
4,418 |
3,983 |
$74K |
| D1120 |
Prophylaxis - child |
2,337 |
2,119 |
$58K |
| D0330 |
Panoramic radiographic image |
1,322 |
1,179 |
$50K |
| D1999 |
|
3,060 |
2,351 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,791 |
3,459 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,811 |
1,625 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,258 |
1,107 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
258 |
145 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
863 |
763 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,118 |
1,022 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
30 |
24 |
$17K |
| D9222 |
|
153 |
129 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
584 |
512 |
$14K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
150 |
128 |
$14K |
| D2740 |
Crown - porcelain/ceramic |
31 |
16 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,409 |
1,194 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
649 |
521 |
$12K |
| D2950 |
|
71 |
43 |
$5K |
| D1351 |
Sealant - per tooth |
246 |
67 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
46 |
27 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
115 |
69 |
$983.00 |
| D1330 |
|
16 |
16 |
$0.00 |