| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,994 |
2,090 |
$288K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,045 |
1,281 |
$192K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,759 |
1,603 |
$149K |
| D0274 |
Bitewings - four radiographic images |
5,328 |
5,088 |
$144K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,196 |
4,017 |
$135K |
| D1110 |
Prophylaxis - adult |
3,011 |
2,909 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,277 |
839 |
$113K |
| D1120 |
Prophylaxis - child |
3,481 |
3,338 |
$101K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,974 |
5,475 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,040 |
4,803 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
7,073 |
6,650 |
$74K |
| D0140 |
Limited oral evaluation - problem focused |
2,074 |
1,934 |
$57K |
| D0120 |
Periodic oral evaluation - established patient |
2,492 |
2,396 |
$51K |
| D2335 |
|
391 |
232 |
$49K |
| D2331 |
|
459 |
331 |
$39K |
| D0330 |
Panoramic radiographic image |
743 |
719 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
253 |
125 |
$29K |
| D2330 |
|
410 |
250 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
493 |
431 |
$18K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
558 |
514 |
$15K |
| D2332 |
|
56 |
37 |
$6K |
| D1351 |
Sealant - per tooth |
262 |
75 |
$6K |
| D2394 |
|
54 |
42 |
$6K |
| D4341 |
|
25 |
12 |
$3K |
| D0240 |
|
275 |
143 |
$3K |
| D1206 |
Topical application of fluoride varnish |
79 |
79 |
$2K |
| D5411 |
|
15 |
14 |
$467.79 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$261.45 |