| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,056 |
1,377 |
$211K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,875 |
874 |
$198K |
| D1110 |
Prophylaxis - adult |
2,933 |
2,918 |
$191K |
| D0120 |
Periodic oral evaluation - established patient |
4,102 |
4,093 |
$173K |
| D0274 |
Bitewings - four radiographic images |
3,074 |
3,065 |
$152K |
| D1206 |
Topical application of fluoride varnish |
4,244 |
4,236 |
$144K |
| D1120 |
Prophylaxis - child |
2,698 |
2,692 |
$124K |
| D0330 |
Panoramic radiographic image |
1,162 |
1,157 |
$103K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,225 |
914 |
$97K |
| D0140 |
Limited oral evaluation - problem focused |
2,110 |
2,073 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,751 |
1,743 |
$82K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
778 |
491 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
3,005 |
2,901 |
$54K |
| D1354 |
|
1,260 |
562 |
$47K |
| D0350 |
|
338 |
335 |
$29K |
| D1351 |
Sealant - per tooth |
625 |
185 |
$24K |
| D2331 |
|
144 |
114 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,338 |
725 |
$16K |
| D2140 |
|
109 |
77 |
$9K |
| D2160 |
|
64 |
50 |
$8K |
| D1330 |
|
226 |
226 |
$6K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
22 |
13 |
$6K |
| D0272 |
Bitewings - two radiographic images |
143 |
143 |
$5K |
| D9410 |
|
140 |
130 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
40 |
33 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
35 |
25 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
146 |
125 |
$4K |
| D4910 |
|
41 |
40 |
$4K |
| D2330 |
|
38 |
27 |
$4K |
| D2332 |
|
22 |
16 |
$3K |
| D2335 |
|
23 |
14 |
$3K |
| D0270 |
|
91 |
91 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$294.61 |
| D9985 |
|
30 |
28 |
$17.82 |
| D3120 |
|
371 |
307 |
$0.00 |