| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,779 |
970 |
$192K |
| D1110 |
Prophylaxis - adult |
1,555 |
1,495 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
3,358 |
3,240 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
4,570 |
4,376 |
$69K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
565 |
209 |
$68K |
| D1120 |
Prophylaxis - child |
2,146 |
2,092 |
$64K |
| D1206 |
Topical application of fluoride varnish |
3,672 |
3,548 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
753 |
304 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,511 |
3,522 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
307 |
205 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,046 |
1,007 |
$32K |
| D0330 |
Panoramic radiographic image |
643 |
641 |
$31K |
| D0140 |
Limited oral evaluation - problem focused |
993 |
965 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
299 |
219 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
439 |
434 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
486 |
461 |
$13K |
| D0272 |
Bitewings - two radiographic images |
598 |
598 |
$11K |
| D1320 |
|
303 |
300 |
$10K |
| D1351 |
Sealant - per tooth |
335 |
89 |
$8K |
| D0350 |
|
119 |
119 |
$4K |
| D0602 |
|
366 |
366 |
$3K |
| D0603 |
|
38 |
38 |
$347.70 |