| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,106 |
1,928 |
$326K |
| D1110 |
Prophylaxis - adult |
8,314 |
8,096 |
$317K |
| D0120 |
Periodic oral evaluation - established patient |
11,794 |
11,489 |
$300K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,135 |
1,319 |
$170K |
| D0274 |
Bitewings - four radiographic images |
4,622 |
4,485 |
$142K |
| D1120 |
Prophylaxis - child |
4,783 |
4,636 |
$129K |
| D0330 |
Panoramic radiographic image |
2,132 |
2,044 |
$114K |
| D1206 |
Topical application of fluoride varnish |
5,906 |
5,833 |
$99K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
791 |
268 |
$86K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,656 |
1,577 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,701 |
3,520 |
$58K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
636 |
279 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,761 |
2,535 |
$39K |
| D0160 |
|
606 |
550 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,000 |
960 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,915 |
1,858 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,349 |
1,159 |
$33K |
| D9222 |
|
286 |
283 |
$21K |
| D7240 |
Removal of impacted tooth - completely bony |
69 |
24 |
$14K |
| D9610 |
|
291 |
287 |
$10K |
| D1351 |
Sealant - per tooth |
197 |
48 |
$6K |
| D4355 |
|
74 |
69 |
$5K |
| D7230 |
|
25 |
13 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
57 |
38 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$2K |