| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,362 |
591 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
624 |
309 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,272 |
1,241 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
292 |
191 |
$25K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
625 |
589 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
924 |
902 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
291 |
103 |
$21K |
| D1110 |
Prophylaxis - adult |
691 |
669 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
527 |
507 |
$12K |
| D1120 |
Prophylaxis - child |
571 |
549 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
943 |
916 |
$10K |
| D1351 |
Sealant - per tooth |
417 |
69 |
$7K |
| D0350 |
|
282 |
279 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
628 |
594 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
65 |
29 |
$3K |
| D0330 |
Panoramic radiographic image |
89 |
88 |
$3K |
| D2332 |
|
25 |
12 |
$2K |
| D2950 |
|
17 |
15 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
45 |
37 |
$843.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
49 |
48 |
$341.70 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$308.00 |