| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,487 |
1,446 |
$248K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,007 |
1,118 |
$177K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,057 |
310 |
$121K |
| D1110 |
Prophylaxis - adult |
1,957 |
1,857 |
$78K |
| D1120 |
Prophylaxis - child |
2,359 |
2,257 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
799 |
454 |
$65K |
| D0120 |
Periodic oral evaluation - established patient |
2,828 |
2,700 |
$64K |
| D1206 |
Topical application of fluoride varnish |
2,895 |
2,758 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,825 |
1,745 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
868 |
816 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
327 |
58 |
$36K |
| D0330 |
Panoramic radiographic image |
640 |
622 |
$19K |
| D0274 |
Bitewings - four radiographic images |
879 |
839 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
956 |
914 |
$18K |
| D0272 |
Bitewings - two radiographic images |
935 |
891 |
$14K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
278 |
254 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
724 |
679 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
154 |
145 |
$3K |
| D1351 |
Sealant - per tooth |
73 |
30 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
245 |
233 |
$2K |
| D2332 |
|
21 |
12 |
$1K |
| D1330 |
|
232 |
219 |
$0.00 |
| D9986 |
|
62 |
62 |
$0.00 |
| D1999 |
|
36 |
30 |
$0.00 |