| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,939 |
1,231 |
$197K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,573 |
952 |
$123K |
| D0140 |
Limited oral evaluation - problem focused |
3,457 |
3,105 |
$120K |
| D1110 |
Prophylaxis - adult |
2,900 |
2,704 |
$108K |
| D2335 |
|
870 |
452 |
$104K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
745 |
508 |
$95K |
| D0120 |
Periodic oral evaluation - established patient |
3,048 |
2,859 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,768 |
1,622 |
$73K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
662 |
309 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
3,841 |
3,380 |
$55K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,142 |
2,927 |
$51K |
| D1120 |
Prophylaxis - child |
1,837 |
1,709 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,517 |
1,407 |
$46K |
| D2332 |
|
477 |
281 |
$44K |
| D0330 |
Panoramic radiographic image |
722 |
688 |
$40K |
| D7140 |
Extraction, erupted tooth or exposed root |
586 |
339 |
$36K |
| D2394 |
|
234 |
137 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,739 |
1,322 |
$32K |
| D1351 |
Sealant - per tooth |
782 |
183 |
$22K |
| D4355 |
|
291 |
277 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
297 |
263 |
$19K |
| D0272 |
Bitewings - two radiographic images |
787 |
730 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
29 |
26 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
221 |
191 |
$10K |
| D3310 |
|
24 |
13 |
$7K |
| D7311 |
|
35 |
29 |
$4K |