| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,919 |
1,297 |
$298K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,440 |
855 |
$209K |
| D1110 |
Prophylaxis - adult |
2,295 |
2,263 |
$98K |
| D1320 |
|
2,618 |
2,586 |
$85K |
| D0330 |
Panoramic radiographic image |
1,523 |
1,490 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
3,166 |
3,128 |
$62K |
| D3120 |
|
1,884 |
610 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
410 |
166 |
$51K |
| D0274 |
Bitewings - four radiographic images |
1,676 |
1,651 |
$50K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,138 |
3,116 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,584 |
1,398 |
$41K |
| D1120 |
Prophylaxis - child |
1,397 |
1,380 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,578 |
2,467 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,270 |
1,214 |
$37K |
| D2394 |
|
227 |
187 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
632 |
620 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,828 |
1,434 |
$14K |
| D1206 |
Topical application of fluoride varnish |
537 |
510 |
$10K |
| D0350 |
|
169 |
169 |
$5K |
| D0272 |
Bitewings - two radiographic images |
253 |
253 |
$4K |
| D2332 |
|
19 |
13 |
$2K |
| D0602 |
|
107 |
107 |
$967.24 |
| D0603 |
|
105 |
105 |
$951.60 |
| D1351 |
Sealant - per tooth |
35 |
12 |
$854.00 |
| D0601 |
|
13 |
13 |
$118.95 |