| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,655 |
2,481 |
$398K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,745 |
833 |
$389K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,811 |
933 |
$316K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,904 |
1,516 |
$262K |
| D1110 |
Prophylaxis - adult |
4,351 |
3,997 |
$194K |
| D0210 |
Intraoral - complete series of radiographic images |
3,333 |
3,026 |
$188K |
| D1351 |
Sealant - per tooth |
6,800 |
1,336 |
$158K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,351 |
3,032 |
$117K |
| D0120 |
Periodic oral evaluation - established patient |
5,345 |
4,821 |
$111K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,721 |
1,032 |
$101K |
| D0274 |
Bitewings - four radiographic images |
2,898 |
2,598 |
$85K |
| D2332 |
|
737 |
392 |
$84K |
| D0140 |
Limited oral evaluation - problem focused |
2,381 |
2,179 |
$83K |
| D1206 |
Topical application of fluoride varnish |
3,955 |
3,556 |
$61K |
| D1120 |
Prophylaxis - child |
2,285 |
2,026 |
$60K |
| D4346 |
|
347 |
323 |
$54K |
| D2335 |
|
329 |
162 |
$54K |
| D0330 |
Panoramic radiographic image |
1,165 |
1,019 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
3,175 |
2,869 |
$37K |
| D2394 |
|
268 |
180 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,904 |
1,579 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
483 |
417 |
$8K |
| D0272 |
Bitewings - two radiographic images |
148 |
141 |
$3K |
| D4910 |
|
15 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
82 |
67 |
$1K |
| D0270 |
|
46 |
43 |
$750.47 |
| D0431 |
|
15 |
14 |
$0.00 |
| D9215 |
|
42 |
40 |
$0.00 |