| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,062 |
2,211 |
$271K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,350 |
1,235 |
$220K |
| D0210 |
Intraoral - complete series of radiographic images |
1,752 |
1,752 |
$208K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
798 |
607 |
$132K |
| D1110 |
Prophylaxis - adult |
2,711 |
2,710 |
$129K |
| D0330 |
Panoramic radiographic image |
2,601 |
2,599 |
$71K |
| D1120 |
Prophylaxis - child |
1,255 |
1,254 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,783 |
1,077 |
$57K |
| D4341 |
|
680 |
224 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,178 |
1,152 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,084 |
2,084 |
$9K |
| D1351 |
Sealant - per tooth |
2,269 |
388 |
$8K |
| D2331 |
|
163 |
119 |
$5K |
| D0274 |
Bitewings - four radiographic images |
3,645 |
3,643 |
$2K |
| D4910 |
|
25 |
25 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,319 |
3,317 |
$310.96 |
| D0120 |
Periodic oral evaluation - established patient |
3,036 |
3,033 |
$214.95 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
226 |
217 |
$97.42 |
| D0220 |
Intraoral - periapical first radiographic image |
2,046 |
2,024 |
$34.82 |
| D1999 |
|
12 |
12 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
1,130 |
1,128 |
$0.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,717 |
1,350 |
$0.00 |
| D0240 |
|
438 |
220 |
$0.00 |