| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,386 |
1,170 |
$272K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,720 |
866 |
$261K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,260 |
407 |
$153K |
| D1110 |
Prophylaxis - adult |
2,541 |
2,450 |
$115K |
| D0330 |
Panoramic radiographic image |
1,929 |
1,889 |
$94K |
| D1206 |
Topical application of fluoride varnish |
4,829 |
4,621 |
$84K |
| D0274 |
Bitewings - four radiographic images |
2,597 |
2,529 |
$79K |
| D0220 |
Intraoral - periapical first radiographic image |
4,982 |
4,816 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
3,513 |
3,364 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,981 |
1,918 |
$58K |
| D1120 |
Prophylaxis - child |
1,839 |
1,759 |
$55K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,160 |
3,925 |
$47K |
| D1320 |
|
785 |
765 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
710 |
702 |
$21K |
| D2394 |
|
103 |
78 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
248 |
157 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
175 |
84 |
$12K |
| D0272 |
Bitewings - two radiographic images |
608 |
594 |
$11K |
| D0350 |
|
357 |
357 |
$11K |
| D4341 |
|
42 |
13 |
$6K |
| D1351 |
Sealant - per tooth |
116 |
30 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
87 |
83 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
31 |
16 |
$823.49 |
| D4910 |
|
12 |
12 |
$801.68 |