| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,540 |
1,339 |
$281K |
| D1110 |
Prophylaxis - adult |
2,857 |
2,757 |
$132K |
| D0120 |
Periodic oral evaluation - established patient |
4,651 |
4,480 |
$99K |
| D1120 |
Prophylaxis - child |
3,157 |
3,031 |
$96K |
| D0330 |
Panoramic radiographic image |
1,530 |
1,490 |
$75K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
533 |
161 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,975 |
1,926 |
$61K |
| D1206 |
Topical application of fluoride varnish |
3,168 |
2,946 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
3,456 |
3,193 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
837 |
615 |
$49K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,618 |
1,403 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,382 |
1,330 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,257 |
1,218 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,374 |
2,374 |
$36K |
| D0272 |
Bitewings - two radiographic images |
1,532 |
1,470 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
164 |
106 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,386 |
785 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
58 |
29 |
$4K |
| D2331 |
|
16 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$396.37 |