| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,548 |
1,152 |
$197K |
| D0210 |
Intraoral - complete series of radiographic images |
2,692 |
2,140 |
$149K |
| D1110 |
Prophylaxis - adult |
2,880 |
2,648 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,119 |
2,839 |
$112K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
810 |
447 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,174 |
2,910 |
$72K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
418 |
166 |
$68K |
| D0274 |
Bitewings - four radiographic images |
1,903 |
1,752 |
$65K |
| D1206 |
Topical application of fluoride varnish |
2,041 |
1,881 |
$36K |
| D1120 |
Prophylaxis - child |
1,098 |
1,020 |
$29K |
| D4346 |
|
108 |
99 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,452 |
1,346 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
255 |
161 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
194 |
56 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,281 |
1,143 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
89 |
85 |
$3K |
| D2394 |
|
20 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
67 |
58 |
$796.36 |
| D0330 |
Panoramic radiographic image |
40 |
32 |
$258.08 |