| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,228 |
1,106 |
$192K |
| D1120 |
Prophylaxis - child |
7,418 |
6,042 |
$179K |
| D0140 |
Limited oral evaluation - problem focused |
5,695 |
4,363 |
$173K |
| D0330 |
Panoramic radiographic image |
5,016 |
4,015 |
$151K |
| D1206 |
Topical application of fluoride varnish |
6,744 |
5,603 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,039 |
3,071 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
3,535 |
3,100 |
$82K |
| D7140 |
Extraction, erupted tooth or exposed root |
983 |
469 |
$58K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
797 |
415 |
$48K |
| D0274 |
Bitewings - four radiographic images |
2,632 |
2,130 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
979 |
642 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,231 |
2,638 |
$28K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
222 |
134 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,441 |
1,170 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
118 |
55 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
479 |
224 |
$4K |
| D1351 |
Sealant - per tooth |
83 |
15 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
108 |
52 |
$1K |
| D1110 |
Prophylaxis - adult |
54 |
47 |
$685.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
18 |
13 |
$274.12 |
| D1999 |
|
1,497 |
1,187 |
$0.00 |
| D9987 |
|
574 |
484 |
$0.00 |
| D9986 |
|
2,112 |
1,848 |
$0.00 |