| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,044 |
2,294 |
$494K |
| D1110 |
Prophylaxis - adult |
3,361 |
3,361 |
$194K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,297 |
856 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
4,124 |
4,122 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,613 |
3,611 |
$103K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,109 |
593 |
$98K |
| D1120 |
Prophylaxis - child |
1,934 |
1,934 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,427 |
782 |
$77K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,164 |
392 |
$66K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,999 |
1,998 |
$28K |
| D1206 |
Topical application of fluoride varnish |
714 |
714 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
728 |
717 |
$10K |
| D1351 |
Sealant - per tooth |
259 |
73 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
27 |
$4K |
| D2394 |
|
16 |
12 |
$2K |
| D4341 |
|
38 |
14 |
$2K |