| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,703 |
1,895 |
$264K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,302 |
1,165 |
$183K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
185 |
156 |
$108K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,904 |
3,510 |
$107K |
| D1110 |
Prophylaxis - adult |
2,076 |
2,005 |
$84K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,753 |
3,637 |
$76K |
| D2750 |
|
139 |
86 |
$64K |
| D0330 |
Panoramic radiographic image |
1,875 |
1,790 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,243 |
2,137 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,029 |
668 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,349 |
2,296 |
$55K |
| D1120 |
Prophylaxis - child |
1,679 |
1,632 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,059 |
1,986 |
$52K |
| D2950 |
|
466 |
294 |
$52K |
| D2954 |
|
314 |
168 |
$49K |
| D2394 |
|
527 |
307 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,369 |
2,806 |
$30K |
| D3310 |
|
53 |
25 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,226 |
1,181 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
611 |
587 |
$13K |
| D1351 |
Sealant - per tooth |
406 |
130 |
$12K |
| D2335 |
|
165 |
61 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,392 |
1,122 |
$11K |
| D2931 |
|
58 |
39 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
123 |
67 |
$7K |
| D9945 |
|
18 |
13 |
$4K |
| D2332 |
|
23 |
13 |
$2K |