| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,082 |
1,920 |
$138K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,140 |
1,297 |
$105K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,035 |
1,173 |
$87K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,072 |
854 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,307 |
2,299 |
$55K |
| D4341 |
|
287 |
102 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
3,063 |
2,981 |
$50K |
| D1120 |
Prophylaxis - child |
2,363 |
2,358 |
$41K |
| D1110 |
Prophylaxis - adult |
1,661 |
1,657 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
6,267 |
6,151 |
$40K |
| D1206 |
Topical application of fluoride varnish |
3,681 |
3,668 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
3,167 |
3,161 |
$37K |
| D0274 |
Bitewings - four radiographic images |
2,316 |
2,312 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,401 |
4,028 |
$25K |
| D4910 |
|
292 |
289 |
$24K |
| D2332 |
|
242 |
175 |
$22K |
| D1351 |
Sealant - per tooth |
1,237 |
475 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
958 |
954 |
$19K |
| D2331 |
|
225 |
139 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
368 |
349 |
$10K |
| D7250 |
|
197 |
100 |
$8K |
| D0272 |
Bitewings - two radiographic images |
742 |
740 |
$7K |
| D2335 |
|
98 |
79 |
$5K |
| D9310 |
|
53 |
53 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
56 |
51 |
$3K |
| D0270 |
|
934 |
917 |
$3K |
| D2330 |
|
17 |
12 |
$2K |
| D0601 |
|
780 |
780 |
$825.00 |
| D0191 |
|
209 |
209 |
$450.00 |
| D1330 |
|
1,031 |
1,024 |
$220.00 |
| D0602 |
|
144 |
144 |
$198.00 |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$43.00 |
| D9986 |
|
333 |
326 |
$0.00 |
| D1310 |
|
150 |
149 |
$0.00 |