| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2332 |
|
2,063 |
337 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,335 |
537 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
786 |
387 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
785 |
291 |
$27K |
| D1110 |
Prophylaxis - adult |
699 |
672 |
$21K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
704 |
674 |
$17K |
| D2335 |
|
221 |
100 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
254 |
139 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
838 |
782 |
$14K |
| D0330 |
Panoramic radiographic image |
587 |
559 |
$12K |
| D4341 |
|
423 |
127 |
$10K |
| D0274 |
Bitewings - four radiographic images |
966 |
926 |
$9K |
| D2394 |
|
116 |
63 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,128 |
1,058 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
320 |
316 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
420 |
409 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
942 |
836 |
$1K |
| D9440 |
|
38 |
31 |
$1K |
| D0270 |
|
172 |
159 |
$727.44 |
| D1999 |
|
46 |
37 |
$375.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
15 |
$280.00 |
| D0350 |
|
12 |
12 |
$0.00 |