| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,930 |
1,886 |
$279K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
940 |
740 |
$110K |
| D1110 |
Prophylaxis - adult |
2,091 |
2,091 |
$103K |
| D0274 |
Bitewings - four radiographic images |
3,011 |
3,011 |
$81K |
| D0140 |
Limited oral evaluation - problem focused |
2,046 |
2,038 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,030 |
2,030 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
625 |
509 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,115 |
1,115 |
$44K |
| D0330 |
Panoramic radiographic image |
843 |
843 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,307 |
2,307 |
$37K |
| D1120 |
Prophylaxis - child |
841 |
841 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,363 |
2,327 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
334 |
199 |
$28K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
26 |
26 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
98 |
78 |
$14K |
| D2950 |
|
73 |
66 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
233 |
225 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
404 |
344 |
$4K |
| D2332 |
|
17 |
13 |
$2K |
| D0270 |
|
116 |
116 |
$1K |
| D2331 |
|
14 |
12 |
$1K |