| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,309 |
895 |
$190K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,614 |
2,502 |
$118K |
| D1110 |
Prophylaxis - adult |
2,032 |
1,950 |
$116K |
| D0330 |
Panoramic radiographic image |
2,302 |
2,199 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,597 |
565 |
$94K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
819 |
369 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
802 |
431 |
$90K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,144 |
562 |
$72K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,521 |
2,405 |
$56K |
| D0274 |
Bitewings - four radiographic images |
2,509 |
2,405 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
921 |
892 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,749 |
1,677 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
528 |
512 |
$18K |
| D4341 |
|
259 |
69 |
$12K |
| D2331 |
|
68 |
39 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,092 |
948 |
$5K |
| D2332 |
|
44 |
29 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
107 |
101 |
$4K |
| D1120 |
Prophylaxis - child |
88 |
82 |
$2K |
| D1999 |
|
93 |
81 |
$1K |
| D1206 |
Topical application of fluoride varnish |
71 |
45 |
$1K |
| D9630 |
|
14 |
12 |
$540.00 |
| D0272 |
Bitewings - two radiographic images |
39 |
38 |
$411.81 |