| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,954 |
819 |
$321K |
| D0330 |
Panoramic radiographic image |
2,506 |
2,289 |
$220K |
| D1110 |
Prophylaxis - adult |
2,598 |
2,396 |
$205K |
| D0274 |
Bitewings - four radiographic images |
3,078 |
2,824 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,408 |
2,212 |
$142K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,756 |
3,505 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
704 |
367 |
$90K |
| D0120 |
Periodic oral evaluation - established patient |
1,988 |
1,887 |
$86K |
| D1351 |
Sealant - per tooth |
1,596 |
270 |
$69K |
| D2740 |
Crown - porcelain/ceramic |
50 |
38 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
240 |
92 |
$34K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
594 |
542 |
$31K |
| D1120 |
Prophylaxis - child |
435 |
420 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
916 |
885 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
241 |
233 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
41 |
27 |
$9K |
| D2950 |
|
28 |
25 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
13 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
95 |
28 |
$2K |