| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,480 |
1,219 |
$264K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
757 |
434 |
$117K |
| D1110 |
Prophylaxis - adult |
1,283 |
1,283 |
$59K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
427 |
115 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,668 |
1,668 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
2,226 |
2,226 |
$47K |
| D1120 |
Prophylaxis - child |
1,513 |
1,513 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,916 |
2,871 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,814 |
2,814 |
$42K |
| D0330 |
Panoramic radiographic image |
808 |
808 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
603 |
316 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
829 |
829 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,159 |
2,297 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
408 |
341 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
260 |
260 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
27 |
$2K |