| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,849 |
2,127 |
$493K |
| D1110 |
Prophylaxis - adult |
6,443 |
6,313 |
$425K |
| D0120 |
Periodic oral evaluation - established patient |
9,543 |
9,376 |
$292K |
| D2750 |
|
528 |
380 |
$245K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,430 |
1,328 |
$232K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,632 |
7,504 |
$181K |
| D1120 |
Prophylaxis - child |
3,626 |
3,575 |
$160K |
| D0274 |
Bitewings - four radiographic images |
4,381 |
4,291 |
$154K |
| D0140 |
Limited oral evaluation - problem focused |
3,399 |
3,290 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,863 |
1,805 |
$119K |
| D0330 |
Panoramic radiographic image |
1,356 |
1,322 |
$85K |
| D1351 |
Sealant - per tooth |
2,343 |
456 |
$81K |
| D4341 |
|
370 |
139 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,738 |
1,708 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
474 |
259 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,587 |
2,497 |
$39K |
| D2394 |
|
201 |
160 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
512 |
505 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
217 |
149 |
$33K |
| D9310 |
|
240 |
235 |
$18K |
| D8670 |
Periodic orthodontic treatment visit |
422 |
411 |
$15K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
383 |
372 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
49 |
26 |
$6K |
| D7250 |
|
18 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
176 |
163 |
$2K |
| D2954 |
|
31 |
25 |
$2K |
| D1206 |
Topical application of fluoride varnish |
86 |
86 |
$2K |
| D1330 |
|
149 |
143 |
$897.60 |
| D2950 |
|
75 |
62 |
$891.00 |