| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,656 |
2,421 |
$243K |
| D0120 |
Periodic oral evaluation - established patient |
5,106 |
5,103 |
$208K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,725 |
792 |
$197K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,973 |
2,971 |
$174K |
| D1120 |
Prophylaxis - child |
5,165 |
5,163 |
$153K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,613 |
1,216 |
$128K |
| D0210 |
Intraoral - complete series of radiographic images |
2,340 |
2,338 |
$106K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
224 |
207 |
$104K |
| D1110 |
Prophylaxis - adult |
1,227 |
1,226 |
$101K |
| D9430 |
|
2,638 |
2,523 |
$81K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,475 |
1,064 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,913 |
5,912 |
$59K |
| D0274 |
Bitewings - four radiographic images |
2,371 |
2,369 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,415 |
6,249 |
$45K |
| D4341 |
|
673 |
265 |
$44K |
| D0272 |
Bitewings - two radiographic images |
2,494 |
2,494 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
2,430 |
2,371 |
$28K |
| D2330 |
|
299 |
173 |
$22K |
| D1351 |
Sealant - per tooth |
1,014 |
283 |
$22K |
| D4910 |
|
222 |
222 |
$17K |
| D0330 |
Panoramic radiographic image |
578 |
577 |
$16K |
| D3320 |
|
28 |
26 |
$10K |
| D2394 |
|
83 |
72 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
115 |
55 |
$7K |
| D0350 |
|
642 |
426 |
$5K |
| D2331 |
|
30 |
25 |
$2K |
| D2332 |
|
14 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
12 |
12 |
$708.00 |
| D0270 |
|
12 |
12 |
$60.00 |