| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,026 |
548 |
$117K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
781 |
258 |
$97K |
| D1110 |
Prophylaxis - adult |
1,234 |
1,162 |
$57K |
| D1206 |
Topical application of fluoride varnish |
2,509 |
2,401 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,289 |
1,236 |
$40K |
| D0330 |
Panoramic radiographic image |
791 |
753 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,794 |
1,731 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
2,375 |
2,241 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
957 |
899 |
$29K |
| D1120 |
Prophylaxis - child |
881 |
852 |
$26K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
151 |
94 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,956 |
1,735 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
373 |
363 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
128 |
86 |
$8K |
| D1320 |
|
235 |
223 |
$8K |
| D7250 |
|
45 |
13 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
63 |
56 |
$2K |
| D1351 |
Sealant - per tooth |
63 |
13 |
$2K |
| D0350 |
|
44 |
44 |
$1K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$475.80 |