| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,702 |
2,830 |
$383K |
| D9110 |
|
8,303 |
6,239 |
$325K |
| D2394 |
|
2,569 |
1,800 |
$267K |
| D1110 |
Prophylaxis - adult |
4,971 |
4,923 |
$261K |
| D2335 |
|
1,875 |
1,306 |
$247K |
| D2332 |
|
1,745 |
1,119 |
$186K |
| D0220 |
Intraoral - periapical first radiographic image |
11,780 |
9,423 |
$174K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
277 |
208 |
$159K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,689 |
1,130 |
$134K |
| D0274 |
Bitewings - four radiographic images |
3,759 |
3,732 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
5,102 |
5,062 |
$116K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,341 |
6,597 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
1,285 |
1,264 |
$90K |
| D1206 |
Topical application of fluoride varnish |
1,287 |
1,274 |
$32K |
| D1120 |
Prophylaxis - child |
499 |
496 |
$25K |
| D0270 |
|
2,846 |
2,436 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
217 |
102 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
300 |
299 |
$13K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
53 |
37 |
$7K |
| D2954 |
|
30 |
26 |
$6K |
| D2950 |
|
29 |
27 |
$5K |
| D0330 |
Panoramic radiographic image |
54 |
54 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$334.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
27 |
25 |
$315.00 |