| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,180 |
2,807 |
$540K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,866 |
2,153 |
$491K |
| D0120 |
Periodic oral evaluation - established patient |
12,318 |
12,178 |
$306K |
| D2394 |
|
1,768 |
1,039 |
$270K |
| D1110 |
Prophylaxis - adult |
6,615 |
6,533 |
$250K |
| D0330 |
Panoramic radiographic image |
3,431 |
3,344 |
$177K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,651 |
1,208 |
$167K |
| D1206 |
Topical application of fluoride varnish |
9,957 |
9,825 |
$158K |
| D0274 |
Bitewings - four radiographic images |
5,023 |
4,950 |
$157K |
| D1120 |
Prophylaxis - child |
5,506 |
5,461 |
$147K |
| D1351 |
Sealant - per tooth |
5,043 |
1,384 |
$140K |
| D2335 |
|
1,134 |
601 |
$137K |
| D4355 |
|
1,832 |
1,796 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,397 |
964 |
$109K |
| D2332 |
|
1,081 |
647 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,335 |
2,300 |
$98K |
| D0140 |
Limited oral evaluation - problem focused |
2,005 |
1,943 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
641 |
286 |
$66K |
| D0272 |
Bitewings - two radiographic images |
3,304 |
3,284 |
$59K |
| D0220 |
Intraoral - periapical first radiographic image |
2,149 |
2,029 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
270 |
258 |
$11K |
| D4341 |
|
42 |
15 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
277 |
129 |
$3K |
| D2331 |
|
29 |
24 |
$2K |