| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,662 |
818 |
$84K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,130 |
536 |
$45K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
691 |
352 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,112 |
1,079 |
$30K |
| D1110 |
Prophylaxis - adult |
711 |
692 |
$23K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
368 |
225 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,481 |
1,447 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
978 |
924 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
777 |
761 |
$16K |
| D0330 |
Panoramic radiographic image |
608 |
596 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
2,024 |
1,942 |
$14K |
| D1120 |
Prophylaxis - child |
533 |
517 |
$11K |
| D0272 |
Bitewings - two radiographic images |
801 |
779 |
$7K |
| D4341 |
|
276 |
99 |
$7K |
| D0274 |
Bitewings - four radiographic images |
645 |
632 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,120 |
1,443 |
$4K |
| D2332 |
|
75 |
43 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
147 |
143 |
$4K |
| D9630 |
|
207 |
199 |
$3K |
| D7250 |
|
43 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
13 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
26 |
25 |
$460.00 |
| D0270 |
|
60 |
59 |
$288.00 |