| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,528 |
2,493 |
$431K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,590 |
4,575 |
$304K |
| D0120 |
Periodic oral evaluation - established patient |
3,691 |
3,671 |
$271K |
| D1120 |
Prophylaxis - child |
5,920 |
5,886 |
$261K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,060 |
1,635 |
$219K |
| D2740 |
Crown - porcelain/ceramic |
414 |
323 |
$197K |
| D0210 |
Intraoral - complete series of radiographic images |
2,838 |
2,827 |
$136K |
| D1110 |
Prophylaxis - adult |
1,520 |
1,519 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
8,053 |
8,013 |
$125K |
| D0230 |
Intraoral - periapical each additional radiographic image |
28,249 |
5,500 |
$119K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,010 |
546 |
$80K |
| D1351 |
Sealant - per tooth |
2,741 |
824 |
$73K |
| D1310 |
|
1,542 |
1,537 |
$70K |
| D1320 |
|
4,801 |
4,773 |
$59K |
| D0350 |
|
4,951 |
2,056 |
$54K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
420 |
201 |
$50K |
| D0274 |
Bitewings - four radiographic images |
2,259 |
2,249 |
$49K |
| D9993 |
|
736 |
735 |
$47K |
| D4341 |
|
532 |
141 |
$37K |
| D2330 |
|
396 |
199 |
$30K |
| D0603 |
|
1,517 |
1,512 |
$22K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
496 |
463 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,264 |
1,259 |
$15K |
| D4910 |
|
154 |
154 |
$12K |
| D0145 |
Oral evaluation for a patient under three years of age |
181 |
181 |
$12K |
| D0272 |
Bitewings - two radiographic images |
667 |
667 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
128 |
57 |
$7K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
14 |
$7K |
| D2954 |
|
35 |
30 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
78 |
78 |
$3K |
| D9430 |
|
85 |
85 |
$3K |
| D0330 |
Panoramic radiographic image |
45 |
45 |
$1K |
| D1206 |
Topical application of fluoride varnish |
28 |
28 |
$320.00 |