| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,199 |
1,590 |
$321K |
| D1110 |
Prophylaxis - adult |
3,073 |
2,898 |
$112K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,736 |
2,503 |
$108K |
| D0330 |
Panoramic radiographic image |
2,754 |
2,523 |
$107K |
| D0120 |
Periodic oral evaluation - established patient |
4,404 |
4,131 |
$106K |
| D0274 |
Bitewings - four radiographic images |
3,671 |
3,385 |
$102K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,270 |
795 |
$98K |
| D0220 |
Intraoral - periapical first radiographic image |
6,498 |
5,868 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,504 |
4,682 |
$63K |
| D0140 |
Limited oral evaluation - problem focused |
1,831 |
1,677 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
464 |
315 |
$59K |
| D1120 |
Prophylaxis - child |
1,918 |
1,799 |
$50K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
436 |
158 |
$42K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
795 |
732 |
$34K |
| D1206 |
Topical application of fluoride varnish |
1,652 |
1,533 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,175 |
1,106 |
$19K |
| D1351 |
Sealant - per tooth |
711 |
145 |
$18K |
| D0272 |
Bitewings - two radiographic images |
889 |
838 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
27 |
$3K |
| D2332 |
|
19 |
12 |
$2K |
| D2331 |
|
15 |
12 |
$1K |