| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,423 |
1,397 |
$175K |
| D0274 |
Bitewings - four radiographic images |
4,591 |
4,297 |
$135K |
| D1110 |
Prophylaxis - adult |
4,142 |
3,873 |
$133K |
| D0120 |
Periodic oral evaluation - established patient |
5,652 |
5,358 |
$131K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,873 |
5,533 |
$111K |
| D0330 |
Panoramic radiographic image |
1,886 |
1,711 |
$93K |
| D1120 |
Prophylaxis - child |
2,147 |
2,061 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
3,103 |
2,856 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,307 |
742 |
$77K |
| D0220 |
Intraoral - periapical first radiographic image |
5,932 |
5,434 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,824 |
3,940 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,148 |
1,081 |
$43K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
318 |
128 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
386 |
145 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
223 |
166 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
327 |
319 |
$17K |
| D1351 |
Sealant - per tooth |
254 |
52 |
$9K |
| D1206 |
Topical application of fluoride varnish |
232 |
229 |
$6K |
| D0272 |
Bitewings - two radiographic images |
101 |
99 |
$3K |
| D9310 |
|
152 |
125 |
$3K |
| D2330 |
|
41 |
27 |
$2K |
| D3110 |
|
15 |
13 |
$2K |
| D2140 |
|
18 |
13 |
$889.20 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
16 |
16 |
$663.60 |
| D0270 |
|
56 |
55 |
$424.48 |