| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
13,162 |
5,547 |
$784K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
7,571 |
3,458 |
$574K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,968 |
2,903 |
$320K |
| D1110 |
Prophylaxis - adult |
7,532 |
6,908 |
$266K |
| D1120 |
Prophylaxis - child |
7,997 |
7,543 |
$248K |
| D0120 |
Periodic oral evaluation - established patient |
11,087 |
10,320 |
$213K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,260 |
1,576 |
$202K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,886 |
11,864 |
$186K |
| D0274 |
Bitewings - four radiographic images |
7,446 |
6,911 |
$164K |
| D0140 |
Limited oral evaluation - problem focused |
6,214 |
5,746 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,913 |
4,542 |
$124K |
| D0272 |
Bitewings - two radiographic images |
5,044 |
4,736 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
8,360 |
7,726 |
$76K |
| D0210 |
Intraoral - complete series of radiographic images |
1,910 |
1,743 |
$75K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,169 |
2,679 |
$61K |
| D7140 |
Extraction, erupted tooth or exposed root |
741 |
363 |
$38K |
| D1206 |
Topical application of fluoride varnish |
2,288 |
2,252 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,796 |
3,365 |
$29K |
| D2332 |
|
318 |
152 |
$27K |
| D0330 |
Panoramic radiographic image |
637 |
612 |
$20K |
| D2950 |
|
148 |
120 |
$9K |
| D2752 |
|
29 |
24 |
$5K |
| D3320 |
|
13 |
12 |
$5K |
| D1351 |
Sealant - per tooth |
145 |
61 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
62 |
55 |
$2K |
| D0270 |
|
192 |
186 |
$1K |
| D4910 |
|
309 |
294 |
$73.15 |