| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,797 |
1,698 |
$417K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,074 |
1,153 |
$376K |
| D1110 |
Prophylaxis - adult |
5,400 |
5,210 |
$238K |
| D0274 |
Bitewings - four radiographic images |
7,413 |
7,215 |
$221K |
| D0330 |
Panoramic radiographic image |
4,309 |
4,095 |
$207K |
| D0220 |
Intraoral - periapical first radiographic image |
13,638 |
12,962 |
$199K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,558 |
1,061 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
7,661 |
7,392 |
$157K |
| D1120 |
Prophylaxis - child |
5,138 |
4,907 |
$152K |
| D2394 |
|
794 |
555 |
$129K |
| D0230 |
Intraoral - periapical each additional radiographic image |
16,324 |
12,018 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,558 |
3,337 |
$109K |
| D1206 |
Topical application of fluoride varnish |
5,778 |
5,372 |
$104K |
| D0140 |
Limited oral evaluation - problem focused |
2,374 |
2,268 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,506 |
3,506 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
663 |
601 |
$18K |
| D4341 |
|
106 |
53 |
$17K |
| D5214 |
|
12 |
12 |
$11K |
| D5213 |
|
12 |
12 |
$11K |
| D2335 |
|
56 |
29 |
$6K |
| D0601 |
|
591 |
591 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
154 |
69 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
34 |
27 |
$2K |
| D3120 |
|
27 |
15 |
$823.23 |
| D0602 |
|
54 |
54 |
$494.10 |