| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,708 |
1,588 |
$156K |
| D1120 |
Prophylaxis - child |
3,313 |
3,240 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,936 |
4,809 |
$130K |
| D1110 |
Prophylaxis - adult |
3,028 |
2,963 |
$118K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,163 |
704 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
3,161 |
3,096 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,391 |
2,327 |
$61K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,653 |
3,565 |
$49K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
759 |
531 |
$48K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
351 |
106 |
$43K |
| D0210 |
Intraoral - complete series of radiographic images |
762 |
743 |
$42K |
| D0330 |
Panoramic radiographic image |
782 |
766 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
937 |
901 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
607 |
420 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
2,418 |
2,338 |
$18K |
| D9243 |
|
113 |
39 |
$16K |
| D1206 |
Topical application of fluoride varnish |
845 |
844 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
177 |
139 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,023 |
375 |
$5K |
| D9239 |
|
39 |
39 |
$5K |
| D2335 |
|
55 |
28 |
$4K |
| D2332 |
|
54 |
36 |
$3K |
| D2331 |
|
65 |
42 |
$3K |
| D0272 |
Bitewings - two radiographic images |
136 |
132 |
$2K |
| D1321 |
|
89 |
89 |
$1K |
| D2394 |
|
15 |
13 |
$1K |