| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,111 |
1,990 |
$417K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,433 |
802 |
$246K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,429 |
808 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,022 |
1,153 |
$155K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,454 |
3,171 |
$135K |
| D0330 |
Panoramic radiographic image |
3,380 |
3,104 |
$127K |
| D1110 |
Prophylaxis - adult |
3,126 |
2,979 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,822 |
3,559 |
$104K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,574 |
4,900 |
$103K |
| D0120 |
Periodic oral evaluation - established patient |
3,918 |
3,698 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
6,251 |
5,713 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
1,763 |
1,563 |
$57K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,132 |
2,904 |
$49K |
| D1120 |
Prophylaxis - child |
1,897 |
1,740 |
$48K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
995 |
886 |
$40K |
| D4355 |
|
490 |
467 |
$31K |
| D0272 |
Bitewings - two radiographic images |
862 |
799 |
$14K |
| D1351 |
Sealant - per tooth |
432 |
91 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
157 |
60 |
$9K |
| D2332 |
|
88 |
52 |
$9K |
| D2335 |
|
32 |
12 |
$4K |
| D2330 |
|
50 |
29 |
$3K |
| D1206 |
Topical application of fluoride varnish |
31 |
31 |
$503.40 |