| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,381 |
999 |
$153K |
| D0210 |
Intraoral - complete series of radiographic images |
2,399 |
2,154 |
$136K |
| D0330 |
Panoramic radiographic image |
1,854 |
1,809 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,872 |
2,827 |
$88K |
| D0140 |
Limited oral evaluation - problem focused |
2,806 |
2,682 |
$66K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
891 |
190 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
695 |
407 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
704 |
312 |
$47K |
| D1110 |
Prophylaxis - adult |
1,120 |
1,090 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,045 |
1,015 |
$27K |
| D2335 |
|
181 |
77 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,477 |
818 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
422 |
411 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
1,693 |
1,615 |
$10K |
| D2394 |
|
97 |
74 |
$7K |
| D1206 |
Topical application of fluoride varnish |
352 |
346 |
$7K |
| D9243 |
|
213 |
57 |
$7K |
| D9222 |
|
62 |
55 |
$7K |
| D9239 |
|
91 |
89 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
99 |
34 |
$5K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
50 |
13 |
$3K |
| D2950 |
|
24 |
13 |
$3K |
| D1320 |
|
155 |
155 |
$3K |
| D2332 |
|
42 |
25 |
$3K |
| D2140 |
|
47 |
27 |
$2K |
| D9610 |
|
77 |
75 |
$2K |
| D2160 |
|
26 |
19 |
$2K |
| D1120 |
Prophylaxis - child |
41 |
40 |
$1K |
| D9612 |
|
25 |
24 |
$1K |
| D0180 |
|
12 |
12 |
$601.20 |
| D0250 |
|
16 |
14 |
$201.90 |