| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,516 |
840 |
$179K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
646 |
368 |
$104K |
| D1110 |
Prophylaxis - adult |
1,892 |
1,815 |
$84K |
| D0330 |
Panoramic radiographic image |
1,584 |
1,540 |
$77K |
| D1120 |
Prophylaxis - child |
2,555 |
2,473 |
$76K |
| D1206 |
Topical application of fluoride varnish |
3,877 |
3,736 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,104 |
1,991 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,961 |
1,839 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,757 |
2,646 |
$57K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
429 |
146 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,669 |
3,477 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,075 |
1,035 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
442 |
314 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,718 |
2,432 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
684 |
569 |
$18K |
| D0272 |
Bitewings - two radiographic images |
777 |
754 |
$14K |
| D2332 |
|
75 |
40 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
109 |
73 |
$8K |
| D2394 |
|
34 |
24 |
$6K |
| D1351 |
Sealant - per tooth |
137 |
30 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
89 |
89 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
12 |
$1K |
| D0603 |
|
63 |
63 |
$559.15 |
| D0602 |
|
47 |
47 |
$413.75 |
| D0601 |
|
20 |
20 |
$183.00 |