| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2990 |
|
2,293 |
883 |
$365K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,357 |
1,738 |
$229K |
| D1110 |
Prophylaxis - adult |
3,621 |
3,421 |
$169K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,042 |
481 |
$164K |
| D0120 |
Periodic oral evaluation - established patient |
6,163 |
5,805 |
$136K |
| D0274 |
Bitewings - four radiographic images |
3,522 |
3,279 |
$110K |
| D1120 |
Prophylaxis - child |
3,364 |
3,170 |
$106K |
| D1206 |
Topical application of fluoride varnish |
5,024 |
4,732 |
$100K |
| D1354 |
|
1,093 |
314 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,503 |
2,313 |
$84K |
| D0210 |
Intraoral - complete series of radiographic images |
4,096 |
2,060 |
$83K |
| D0140 |
Limited oral evaluation - problem focused |
2,426 |
2,167 |
$83K |
| D0330 |
Panoramic radiographic image |
1,915 |
1,723 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,315 |
797 |
$71K |
| D4346 |
|
266 |
235 |
$46K |
| D1351 |
Sealant - per tooth |
1,737 |
403 |
$44K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
488 |
321 |
$42K |
| D4212 |
|
134 |
56 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,431 |
1,335 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,574 |
2,236 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,085 |
1,359 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
142 |
83 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
246 |
231 |
$7K |
| D7250 |
|
24 |
13 |
$5K |
| D2332 |
|
17 |
12 |
$2K |
| D2330 |
|
19 |
12 |
$1K |
| D9920 |
|
14 |
12 |
$561.00 |
| D0270 |
|
30 |
24 |
$437.99 |
| D1999 |
|
23 |
14 |
$0.00 |