| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,401 |
3,801 |
$799K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,689 |
2,789 |
$608K |
| D1110 |
Prophylaxis - adult |
10,554 |
10,386 |
$403K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,042 |
1,219 |
$331K |
| D2394 |
|
1,667 |
1,091 |
$262K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,919 |
10,279 |
$259K |
| D0274 |
Bitewings - four radiographic images |
7,965 |
7,798 |
$252K |
| D0120 |
Periodic oral evaluation - established patient |
10,158 |
10,009 |
$251K |
| D0330 |
Panoramic radiographic image |
4,653 |
4,520 |
$251K |
| D0220 |
Intraoral - periapical first radiographic image |
13,054 |
12,591 |
$191K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,355 |
1,390 |
$191K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,052 |
3,943 |
$174K |
| D0140 |
Limited oral evaluation - problem focused |
4,681 |
4,523 |
$166K |
| D2332 |
|
1,651 |
1,004 |
$159K |
| D2335 |
|
1,083 |
663 |
$132K |
| D1206 |
Topical application of fluoride varnish |
5,858 |
5,763 |
$96K |
| D2331 |
|
832 |
513 |
$66K |
| D7250 |
|
553 |
205 |
$62K |
| D1120 |
Prophylaxis - child |
2,209 |
2,154 |
$59K |
| D4341 |
|
573 |
245 |
$53K |
| D4355 |
|
683 |
665 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
626 |
544 |
$28K |
| D5110 |
|
38 |
28 |
$16K |
| D0272 |
Bitewings - two radiographic images |
856 |
828 |
$15K |
| D7311 |
|
139 |
90 |
$13K |
| D7310 |
|
113 |
55 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
175 |
67 |
$10K |
| D2330 |
|
146 |
99 |
$9K |
| D5212 |
|
73 |
33 |
$9K |
| D5211 |
|
59 |
27 |
$8K |
| D5120 |
|
13 |
13 |
$8K |
| D4342 |
|
39 |
28 |
$2K |
| D9110 |
|
13 |
12 |
$560.76 |
| D0270 |
|
14 |
13 |
$83.09 |
| D9986 |
|
80 |
78 |
$0.00 |