| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,410 |
3,710 |
$633K |
| D1110 |
Prophylaxis - adult |
12,676 |
11,882 |
$609K |
| D7140 |
Extraction, erupted tooth or exposed root |
9,350 |
2,209 |
$496K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
6,822 |
6,173 |
$288K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,575 |
2,467 |
$287K |
| D0210 |
Intraoral - complete series of radiographic images |
4,497 |
4,100 |
$281K |
| D0120 |
Periodic oral evaluation - established patient |
10,064 |
9,473 |
$258K |
| D1206 |
Topical application of fluoride varnish |
13,763 |
12,760 |
$258K |
| D0274 |
Bitewings - four radiographic images |
8,485 |
7,962 |
$257K |
| D0140 |
Limited oral evaluation - problem focused |
5,821 |
5,261 |
$214K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
228 |
209 |
$145K |
| D1120 |
Prophylaxis - child |
4,362 |
4,069 |
$139K |
| D0330 |
Panoramic radiographic image |
2,304 |
2,110 |
$132K |
| D4346 |
|
1,529 |
1,437 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
5,717 |
5,202 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
554 |
391 |
$79K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,635 |
1,357 |
$76K |
| D2950 |
|
220 |
172 |
$28K |
| D1351 |
Sealant - per tooth |
386 |
86 |
$11K |
| D2750 |
|
14 |
12 |
$5K |
| D1354 |
|
306 |
143 |
$4K |
| D4910 |
|
53 |
52 |
$4K |
| D0272 |
Bitewings - two radiographic images |
133 |
128 |
$3K |
| D4355 |
|
28 |
26 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
77 |
72 |
$2K |
| D2330 |
|
22 |
14 |
$2K |
| D0170 |
|
26 |
26 |
$781.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
111 |
94 |
$750.00 |
| D1999 |
|
1,518 |
1,362 |
$0.00 |