| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,529 |
1,716 |
$349K |
| D8670 |
Periodic orthodontic treatment visit |
3,419 |
3,229 |
$309K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,731 |
910 |
$207K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,984 |
2,686 |
$110K |
| D0330 |
Panoramic radiographic image |
2,729 |
2,444 |
$92K |
| D1110 |
Prophylaxis - adult |
2,393 |
2,225 |
$85K |
| D0274 |
Bitewings - four radiographic images |
3,226 |
2,924 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,275 |
3,573 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
4,531 |
4,074 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,394 |
2,236 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
740 |
675 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
312 |
193 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
226 |
77 |
$22K |
| D1120 |
Prophylaxis - child |
775 |
723 |
$19K |
| D4355 |
|
279 |
252 |
$17K |
| D1206 |
Topical application of fluoride varnish |
833 |
796 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
702 |
651 |
$11K |
| D2394 |
|
36 |
25 |
$6K |
| D4341 |
|
44 |
15 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
26 |
$1K |
| D0272 |
Bitewings - two radiographic images |
74 |
69 |
$1K |
| D0340 |
|
19 |
19 |
$896.58 |
| D0470 |
|
19 |
19 |
$731.88 |
| D4346 |
|
15 |
13 |
$505.79 |