| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,015 |
1,635 |
$231K |
| D1110 |
Prophylaxis - adult |
3,911 |
3,419 |
$176K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
901 |
378 |
$148K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,018 |
3,553 |
$142K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,662 |
526 |
$138K |
| D0210 |
Intraoral - complete series of radiographic images |
2,371 |
1,999 |
$130K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,322 |
774 |
$122K |
| D0274 |
Bitewings - four radiographic images |
3,937 |
3,537 |
$116K |
| D1351 |
Sealant - per tooth |
4,096 |
564 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
3,729 |
3,358 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
2,207 |
1,890 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,452 |
823 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,285 |
4,921 |
$71K |
| D0220 |
Intraoral - periapical first radiographic image |
5,818 |
5,073 |
$66K |
| D1120 |
Prophylaxis - child |
1,837 |
1,695 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,841 |
2,558 |
$53K |
| D0330 |
Panoramic radiographic image |
828 |
721 |
$33K |
| D4346 |
|
65 |
64 |
$12K |
| D1206 |
Topical application of fluoride varnish |
361 |
342 |
$8K |
| D0270 |
|
456 |
389 |
$8K |
| D2335 |
|
44 |
25 |
$7K |
| D2332 |
|
65 |
36 |
$7K |
| D4355 |
|
60 |
56 |
$6K |
| D0272 |
Bitewings - two radiographic images |
97 |
87 |
$2K |
| D4342 |
|
55 |
14 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
47 |
$1K |