| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,230 |
1,185 |
$213K |
| D0120 |
Periodic oral evaluation - established patient |
3,058 |
3,049 |
$184K |
| D1110 |
Prophylaxis - adult |
1,838 |
1,829 |
$157K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,243 |
2,238 |
$141K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,472 |
852 |
$133K |
| D1120 |
Prophylaxis - child |
3,159 |
3,152 |
$125K |
| D2740 |
Crown - porcelain/ceramic |
217 |
145 |
$103K |
| D0230 |
Intraoral - periapical each additional radiographic image |
17,181 |
3,972 |
$80K |
| D0210 |
Intraoral - complete series of radiographic images |
1,552 |
1,548 |
$73K |
| D1206 |
Topical application of fluoride varnish |
4,862 |
4,846 |
$72K |
| D0274 |
Bitewings - four radiographic images |
2,273 |
2,266 |
$48K |
| D9430 |
|
1,243 |
1,202 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
241 |
120 |
$28K |
| D4341 |
|
371 |
99 |
$26K |
| D2954 |
|
205 |
139 |
$22K |
| D1351 |
Sealant - per tooth |
702 |
210 |
$22K |
| D1310 |
|
413 |
412 |
$19K |
| D9993 |
|
257 |
257 |
$17K |
| D4910 |
|
181 |
181 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
861 |
839 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
15 |
$8K |
| D0330 |
Panoramic radiographic image |
193 |
193 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
78 |
76 |
$3K |
| D0272 |
Bitewings - two radiographic images |
239 |
239 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
47 |
25 |
$3K |
| D2330 |
|
24 |
14 |
$2K |
| D0603 |
|
111 |
111 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
134 |
134 |
$1K |
| D0602 |
|
38 |
38 |
$570.00 |
| D0270 |
|
12 |
12 |
$60.00 |