| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,066 |
1,438 |
$220K |
| D0274 |
Bitewings - four radiographic images |
3,252 |
3,224 |
$94K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,312 |
2,280 |
$79K |
| D1120 |
Prophylaxis - child |
1,949 |
1,939 |
$61K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
606 |
350 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
866 |
505 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
4,034 |
3,940 |
$45K |
| D1110 |
Prophylaxis - adult |
918 |
911 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,330 |
1,278 |
$38K |
| D0120 |
Periodic oral evaluation - established patient |
1,530 |
1,524 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,617 |
1,599 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,928 |
2,833 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,303 |
1,298 |
$24K |
| D0330 |
Panoramic radiographic image |
182 |
177 |
$9K |
| D4346 |
|
51 |
51 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
26 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
43 |
26 |
$4K |
| D0272 |
Bitewings - two radiographic images |
74 |
74 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
38 |
29 |
$969.77 |