| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,175 |
808 |
$163K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,415 |
349 |
$153K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,489 |
756 |
$151K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
760 |
336 |
$77K |
| D4341 |
|
1,818 |
436 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,565 |
1,465 |
$64K |
| D0330 |
Panoramic radiographic image |
1,260 |
1,177 |
$47K |
| D7311 |
|
250 |
155 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,304 |
1,085 |
$39K |
| D1110 |
Prophylaxis - adult |
865 |
805 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,416 |
1,318 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,543 |
1,453 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
626 |
588 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,670 |
1,524 |
$17K |
| D2332 |
|
97 |
46 |
$9K |
| D2330 |
|
143 |
66 |
$9K |
| D1120 |
Prophylaxis - child |
354 |
335 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
165 |
156 |
$6K |
| D9630 |
|
138 |
129 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
379 |
353 |
$5K |
| D2331 |
|
58 |
26 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,274 |
1,146 |
$3K |
| D1351 |
Sealant - per tooth |
163 |
33 |
$3K |
| D1999 |
|
128 |
106 |
$1K |
| D9920 |
|
16 |
14 |
$309.10 |
| D9999 |
Unspecified adjunctive procedure, by report |
15 |
13 |
$0.00 |