| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,205 |
562 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
888 |
385 |
$52K |
| D2335 |
|
407 |
128 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,352 |
1,260 |
$30K |
| D7140 |
Extraction, erupted tooth or exposed root |
697 |
313 |
$25K |
| D1110 |
Prophylaxis - adult |
711 |
653 |
$24K |
| D2394 |
|
321 |
155 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
420 |
375 |
$20K |
| D1120 |
Prophylaxis - child |
427 |
405 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
421 |
212 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
369 |
304 |
$13K |
| D2332 |
|
147 |
85 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
650 |
612 |
$9K |
| D0330 |
Panoramic radiographic image |
248 |
239 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
581 |
535 |
$4K |
| D0272 |
Bitewings - two radiographic images |
247 |
238 |
$4K |
| D0274 |
Bitewings - four radiographic images |
127 |
122 |
$3K |
| D9110 |
|
102 |
88 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
15 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
309 |
135 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
27 |
25 |
$786.90 |
| D9986 |
|
1,018 |
775 |
$192.00 |