| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,499 |
3,570 |
$670K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,624 |
2,766 |
$567K |
| D2394 |
|
3,412 |
1,851 |
$491K |
| D1110 |
Prophylaxis - adult |
8,581 |
8,414 |
$317K |
| D0120 |
Periodic oral evaluation - established patient |
11,526 |
11,326 |
$284K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,158 |
10,158 |
$274K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,778 |
1,668 |
$214K |
| D0330 |
Panoramic radiographic image |
4,262 |
4,144 |
$205K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,823 |
832 |
$194K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,639 |
3,905 |
$192K |
| D0220 |
Intraoral - periapical first radiographic image |
13,098 |
12,598 |
$188K |
| D0274 |
Bitewings - four radiographic images |
5,949 |
5,827 |
$143K |
| D0140 |
Limited oral evaluation - problem focused |
4,155 |
3,997 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,665 |
3,534 |
$130K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,926 |
7,749 |
$128K |
| D1120 |
Prophylaxis - child |
4,889 |
4,781 |
$128K |
| D2335 |
|
1,104 |
606 |
$124K |
| D2332 |
|
1,054 |
662 |
$97K |
| D0272 |
Bitewings - two radiographic images |
2,123 |
2,081 |
$36K |
| D4355 |
|
458 |
446 |
$30K |
| D1351 |
Sealant - per tooth |
628 |
177 |
$18K |
| D2331 |
|
155 |
106 |
$12K |
| D7311 |
|
121 |
85 |
$11K |
| D4341 |
|
114 |
56 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
144 |
70 |
$9K |
| D2330 |
|
44 |
26 |
$3K |
| D1206 |
Topical application of fluoride varnish |
133 |
133 |
$2K |
| D4342 |
|
22 |
12 |
$1K |
| D9110 |
|
13 |
12 |
$563.76 |
| D4346 |
|
15 |
15 |
$398.31 |