| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,694 |
1,013 |
$127K |
| D1110 |
Prophylaxis - adult |
1,651 |
1,470 |
$81K |
| D7140 |
Extraction, erupted tooth or exposed root |
875 |
300 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,272 |
2,039 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,412 |
1,221 |
$51K |
| D0330 |
Panoramic radiographic image |
1,168 |
973 |
$51K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
890 |
592 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,582 |
1,385 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,118 |
953 |
$43K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
407 |
285 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
751 |
536 |
$28K |
| D1120 |
Prophylaxis - child |
744 |
664 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
893 |
807 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
719 |
604 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,496 |
1,270 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
97 |
29 |
$16K |
| D1206 |
Topical application of fluoride varnish |
476 |
419 |
$11K |
| D2335 |
|
81 |
51 |
$11K |
| D1351 |
Sealant - per tooth |
417 |
74 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
606 |
424 |
$6K |
| D0272 |
Bitewings - two radiographic images |
188 |
165 |
$4K |
| D2394 |
|
18 |
14 |
$2K |
| D2332 |
|
18 |
12 |
$2K |