| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,882 |
981 |
$168K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,181 |
2,973 |
$105K |
| D1120 |
Prophylaxis - child |
3,674 |
3,465 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
2,195 |
1,900 |
$70K |
| D0330 |
Panoramic radiographic image |
1,058 |
994 |
$45K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
596 |
397 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
537 |
316 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,626 |
2,496 |
$37K |
| D1351 |
Sealant - per tooth |
1,288 |
244 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,262 |
1,174 |
$29K |
| D1206 |
Topical application of fluoride varnish |
885 |
829 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
119 |
82 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
504 |
494 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,002 |
888 |
$10K |
| D0272 |
Bitewings - two radiographic images |
505 |
498 |
$9K |
| D0350 |
|
354 |
339 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
54 |
26 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
16 |
16 |
$997.80 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
538 |
465 |
$558.84 |
| D0230 |
Intraoral - periapical each additional radiographic image |
36 |
24 |
$350.66 |
| D1999 |
|
537 |
472 |
$0.00 |