| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,098 |
693 |
$164K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
765 |
337 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
2,242 |
1,955 |
$63K |
| D1120 |
Prophylaxis - child |
3,176 |
2,530 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,160 |
1,629 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
734 |
304 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
571 |
273 |
$37K |
| D1206 |
Topical application of fluoride varnish |
2,229 |
1,803 |
$37K |
| D0330 |
Panoramic radiographic image |
1,108 |
902 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
208 |
108 |
$23K |
| D0274 |
Bitewings - four radiographic images |
952 |
876 |
$20K |
| D1351 |
Sealant - per tooth |
748 |
133 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,430 |
1,248 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
570 |
551 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
618 |
489 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
358 |
349 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
45 |
$3K |
| D0272 |
Bitewings - two radiographic images |
202 |
169 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
38 |
33 |
$330.72 |