| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,950 |
3,229 |
$357K |
| D1110 |
Prophylaxis - adult |
4,474 |
4,416 |
$206K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,997 |
5,885 |
$196K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,695 |
1,286 |
$194K |
| D0210 |
Intraoral - complete series of radiographic images |
4,494 |
4,405 |
$191K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,315 |
1,490 |
$179K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,251 |
1,558 |
$174K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,468 |
2,093 |
$160K |
| D0120 |
Periodic oral evaluation - established patient |
3,235 |
3,191 |
$94K |
| D1206 |
Topical application of fluoride varnish |
2,382 |
2,361 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,162 |
2,121 |
$39K |
| D0274 |
Bitewings - four radiographic images |
3,130 |
3,098 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,553 |
1,518 |
$32K |
| D2331 |
|
490 |
330 |
$25K |
| D2332 |
|
335 |
237 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,431 |
2,391 |
$19K |
| D1999 |
|
1,269 |
1,157 |
$17K |
| D2335 |
|
130 |
79 |
$9K |
| D2394 |
|
64 |
52 |
$7K |
| D0330 |
Panoramic radiographic image |
281 |
279 |
$6K |
| D4341 |
|
111 |
48 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
96 |
82 |
$4K |
| D2330 |
|
51 |
38 |
$2K |
| D4346 |
|
33 |
33 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
562 |
208 |
$791.49 |
| D0270 |
|
127 |
127 |
$615.36 |