| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,791 |
2,573 |
$507K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,197 |
1,611 |
$445K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,533 |
1,507 |
$327K |
| D1110 |
Prophylaxis - adult |
8,055 |
7,804 |
$305K |
| D0120 |
Periodic oral evaluation - established patient |
9,694 |
9,552 |
$251K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,100 |
1,775 |
$250K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,979 |
4,676 |
$212K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,206 |
1,365 |
$198K |
| D1120 |
Prophylaxis - child |
5,715 |
5,589 |
$160K |
| D0210 |
Intraoral - complete series of radiographic images |
2,151 |
2,031 |
$142K |
| D0330 |
Panoramic radiographic image |
2,719 |
2,588 |
$140K |
| D0140 |
Limited oral evaluation - problem focused |
3,837 |
3,633 |
$136K |
| D2335 |
|
914 |
430 |
$111K |
| D0274 |
Bitewings - four radiographic images |
3,171 |
3,060 |
$100K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,580 |
5,450 |
$95K |
| D2332 |
|
935 |
538 |
$91K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,963 |
1,898 |
$89K |
| D1206 |
Topical application of fluoride varnish |
3,789 |
3,704 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
4,193 |
3,865 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,988 |
1,723 |
$53K |
| D1351 |
Sealant - per tooth |
1,674 |
346 |
$49K |
| D0272 |
Bitewings - two radiographic images |
2,405 |
2,353 |
$44K |
| D2394 |
|
230 |
153 |
$34K |
| D2330 |
|
401 |
243 |
$27K |
| D7111 |
|
503 |
319 |
$26K |
| D7240 |
Removal of impacted tooth - completely bony |
59 |
26 |
$12K |
| D2331 |
|
103 |
69 |
$8K |
| D7220 |
|
63 |
28 |
$7K |
| D2950 |
|
27 |
26 |
$3K |
| D4355 |
|
13 |
13 |
$883.72 |