| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,666 |
1,530 |
$407K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,450 |
1,536 |
$272K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,273 |
524 |
$155K |
| D0330 |
Panoramic radiographic image |
2,833 |
2,773 |
$138K |
| D1120 |
Prophylaxis - child |
4,555 |
4,389 |
$137K |
| D1110 |
Prophylaxis - adult |
3,038 |
2,955 |
$136K |
| D1206 |
Topical application of fluoride varnish |
7,423 |
7,186 |
$127K |
| D0120 |
Periodic oral evaluation - established patient |
5,740 |
5,547 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,874 |
2,780 |
$86K |
| D0274 |
Bitewings - four radiographic images |
2,701 |
2,629 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
4,253 |
4,065 |
$65K |
| D2394 |
|
433 |
293 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,583 |
1,533 |
$47K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,726 |
1,610 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,528 |
2,836 |
$43K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
333 |
94 |
$40K |
| D0272 |
Bitewings - two radiographic images |
2,095 |
2,005 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
351 |
248 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
193 |
91 |
$13K |
| D0350 |
|
409 |
409 |
$12K |
| D1320 |
|
224 |
224 |
$8K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
24 |
24 |
$6K |
| D2335 |
|
23 |
12 |
$3K |
| D9222 |
|
24 |
24 |
$2K |
| D2331 |
|
13 |
12 |
$1K |
| D7111 |
|
13 |
12 |
$792.74 |
| D9610 |
|
24 |
24 |
$732.00 |