| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,582 |
3,879 |
$704K |
| D1110 |
Prophylaxis - adult |
12,756 |
12,187 |
$625K |
| D7140 |
Extraction, erupted tooth or exposed root |
6,450 |
2,234 |
$606K |
| D0120 |
Periodic oral evaluation - established patient |
18,833 |
17,989 |
$487K |
| D7240 |
Removal of impacted tooth - completely bony |
1,609 |
509 |
$439K |
| D1120 |
Prophylaxis - child |
11,141 |
10,726 |
$415K |
| D1206 |
Topical application of fluoride varnish |
19,927 |
19,070 |
$404K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,376 |
2,292 |
$291K |
| D1351 |
Sealant - per tooth |
11,323 |
1,777 |
$279K |
| D0274 |
Bitewings - four radiographic images |
6,760 |
6,458 |
$211K |
| D9222 |
|
1,060 |
957 |
$151K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
1,071 |
900 |
$151K |
| D0140 |
Limited oral evaluation - problem focused |
3,788 |
3,543 |
$149K |
| D9243 |
|
1,176 |
864 |
$143K |
| D9310 |
|
2,529 |
2,316 |
$136K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,939 |
2,798 |
$135K |
| D9239 |
|
1,046 |
897 |
$133K |
| D0272 |
Bitewings - two radiographic images |
3,551 |
3,461 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
3,257 |
3,098 |
$57K |
| D0210 |
Intraoral - complete series of radiographic images |
830 |
776 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
240 |
146 |
$45K |
| D4346 |
|
515 |
506 |
$36K |
| D0330 |
Panoramic radiographic image |
575 |
530 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
149 |
129 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
324 |
301 |
$18K |
| D7230 |
|
40 |
25 |
$10K |
| D2331 |
|
51 |
36 |
$5K |
| D1354 |
|
160 |
75 |
$3K |
| D2335 |
|
17 |
12 |
$2K |
| D4910 |
|
12 |
12 |
$1K |
| D1330 |
|
13 |
13 |
$387.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
16 |
$175.00 |
| D9986 |
|
2,726 |
2,689 |
$0.00 |