| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,037 |
3,037 |
$198K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,984 |
1,250 |
$131K |
| D1110 |
Prophylaxis - adult |
1,247 |
1,247 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
2,256 |
2,255 |
$106K |
| D1120 |
Prophylaxis - child |
1,771 |
1,771 |
$89K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
844 |
635 |
$66K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
541 |
308 |
$64K |
| D1206 |
Topical application of fluoride varnish |
3,052 |
3,051 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
944 |
594 |
$51K |
| D0350 |
|
4,838 |
1,998 |
$46K |
| D4341 |
|
608 |
215 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
451 |
451 |
$31K |
| D1351 |
Sealant - per tooth |
716 |
218 |
$27K |
| D1310 |
|
548 |
547 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
226 |
90 |
$13K |
| D0330 |
Panoramic radiographic image |
420 |
420 |
$12K |
| D2394 |
|
107 |
96 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,131 |
996 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
132 |
132 |
$8K |
| D4910 |
|
107 |
107 |
$8K |
| D9430 |
|
206 |
205 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
156 |
152 |
$6K |
| D0603 |
|
399 |
398 |
$6K |
| D0272 |
Bitewings - two radiographic images |
383 |
383 |
$4K |
| D0274 |
Bitewings - four radiographic images |
217 |
217 |
$4K |
| D2335 |
|
18 |
12 |
$2K |
| D7111 |
|
31 |
12 |
$2K |
| D4342 |
|
27 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
74 |
74 |
$864.00 |
| D1354 |
|
93 |
14 |
$468.00 |
| D0602 |
|
16 |
16 |
$225.00 |