| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,541 |
1,276 |
$322K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,104 |
269 |
$135K |
| D1110 |
Prophylaxis - adult |
2,533 |
2,523 |
$113K |
| D0120 |
Periodic oral evaluation - established patient |
5,365 |
5,303 |
$111K |
| D0220 |
Intraoral - periapical first radiographic image |
6,969 |
6,805 |
$104K |
| D1120 |
Prophylaxis - child |
3,345 |
3,291 |
$99K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,004 |
627 |
$93K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,006 |
5,704 |
$75K |
| D0330 |
Panoramic radiographic image |
1,532 |
1,526 |
$73K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,570 |
2,326 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,096 |
2,089 |
$63K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,068 |
4,068 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,299 |
1,259 |
$38K |
| D1206 |
Topical application of fluoride varnish |
1,482 |
1,427 |
$26K |
| D1351 |
Sealant - per tooth |
1,056 |
427 |
$25K |
| D1354 |
|
1,054 |
277 |
$24K |
| D2394 |
|
115 |
80 |
$16K |
| D1320 |
|
432 |
367 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
387 |
387 |
$11K |
| D0272 |
Bitewings - two radiographic images |
602 |
602 |
$11K |
| D2335 |
|
29 |
13 |
$4K |
| D0240 |
|
128 |
127 |
$2K |
| D3120 |
|
80 |
41 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
12 |
$2K |