| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,848 |
2,728 |
$639K |
| D1110 |
Prophylaxis - adult |
6,314 |
6,275 |
$269K |
| D0120 |
Periodic oral evaluation - established patient |
6,121 |
6,082 |
$140K |
| D0140 |
Limited oral evaluation - problem focused |
3,806 |
3,770 |
$126K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,182 |
732 |
$122K |
| D0274 |
Bitewings - four radiographic images |
3,931 |
3,906 |
$115K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,081 |
523 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,140 |
2,121 |
$82K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
334 |
243 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
3,620 |
3,563 |
$44K |
| D0210 |
Intraoral - complete series of radiographic images |
586 |
578 |
$43K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
105 |
91 |
$17K |
| D9222 |
|
104 |
90 |
$11K |
| D0330 |
Panoramic radiographic image |
93 |
92 |
$5K |
| D9219 |
|
115 |
115 |
$5K |
| D2950 |
|
30 |
26 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
12 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
182 |
173 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
25 |
14 |
$3K |
| D1120 |
Prophylaxis - child |
12 |
12 |
$505.44 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$499.27 |
| D0460 |
|
13 |
13 |
$348.92 |