| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,319 |
939 |
$179K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
624 |
301 |
$100K |
| D0210 |
Intraoral - complete series of radiographic images |
1,271 |
1,110 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,703 |
1,546 |
$65K |
| D1110 |
Prophylaxis - adult |
1,243 |
1,160 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
541 |
323 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
542 |
253 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
872 |
810 |
$29K |
| D0274 |
Bitewings - four radiographic images |
845 |
770 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,124 |
1,057 |
$27K |
| D4346 |
|
163 |
144 |
$17K |
| D1351 |
Sealant - per tooth |
448 |
73 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,152 |
966 |
$9K |
| D1206 |
Topical application of fluoride varnish |
383 |
349 |
$8K |
| D1120 |
Prophylaxis - child |
169 |
155 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
514 |
312 |
$3K |
| D0330 |
Panoramic radiographic image |
49 |
48 |
$2K |
| D0272 |
Bitewings - two radiographic images |
14 |
12 |
$287.79 |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$246.29 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$225.94 |