| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,265 |
1,938 |
$212K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,656 |
1,437 |
$209K |
| D1120 |
Prophylaxis - child |
5,231 |
5,173 |
$149K |
| D1110 |
Prophylaxis - adult |
3,779 |
3,683 |
$145K |
| D1206 |
Topical application of fluoride varnish |
7,240 |
7,173 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
7,087 |
6,965 |
$118K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,586 |
937 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,897 |
4,760 |
$110K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,416 |
2,254 |
$98K |
| D0210 |
Intraoral - complete series of radiographic images |
2,813 |
2,522 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,369 |
810 |
$84K |
| D9630 |
|
4,967 |
4,796 |
$76K |
| D0330 |
Panoramic radiographic image |
1,745 |
1,122 |
$57K |
| D0274 |
Bitewings - four radiographic images |
2,456 |
2,384 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
3,028 |
2,274 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
7,060 |
5,065 |
$49K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
391 |
142 |
$25K |
| D4355 |
|
578 |
572 |
$25K |
| D0272 |
Bitewings - two radiographic images |
1,164 |
1,159 |
$20K |
| D4910 |
|
310 |
298 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
485 |
459 |
$13K |
| D2332 |
|
248 |
150 |
$13K |
| D2394 |
|
51 |
44 |
$8K |
| D2331 |
|
59 |
41 |
$7K |
| D1351 |
Sealant - per tooth |
307 |
97 |
$4K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
29 |
24 |
$4K |
| D9994 |
|
2,804 |
2,757 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
184 |
184 |
$3K |
| D2335 |
|
19 |
12 |
$3K |
| D4341 |
|
31 |
12 |
$3K |
| D3120 |
|
47 |
35 |
$598.25 |
| D1354 |
|
33 |
18 |
$0.00 |