| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9110 |
|
2,048 |
1,715 |
$140K |
| D7311 |
|
764 |
352 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,634 |
588 |
$127K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
865 |
397 |
$99K |
| D1110 |
Prophylaxis - adult |
1,749 |
1,729 |
$87K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,747 |
1,455 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,460 |
1,440 |
$61K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
567 |
162 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,919 |
1,633 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,660 |
2,621 |
$55K |
| D0330 |
Panoramic radiographic image |
1,389 |
1,371 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
482 |
173 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
1,067 |
1,052 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,720 |
1,694 |
$24K |
| D7240 |
Removal of impacted tooth - completely bony |
85 |
28 |
$16K |
| D1120 |
Prophylaxis - child |
620 |
607 |
$14K |
| D2332 |
|
90 |
36 |
$10K |
| D1999 |
|
432 |
313 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
306 |
294 |
$3K |
| D7510 |
|
14 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$391.02 |
| D1330 |
|
30 |
29 |
$0.00 |