| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
741 |
445 |
$92K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
460 |
164 |
$60K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
344 |
240 |
$58K |
| D1110 |
Prophylaxis - adult |
1,139 |
1,063 |
$53K |
| D0330 |
Panoramic radiographic image |
1,072 |
999 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,449 |
1,391 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
2,536 |
2,360 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,146 |
1,054 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,622 |
1,503 |
$30K |
| D1120 |
Prophylaxis - child |
866 |
807 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,809 |
2,165 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
947 |
875 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
362 |
349 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
53 |
46 |
$1K |
| D0601 |
|
57 |
57 |
$503.25 |
| D1208 |
Topical application of fluoride, excluding varnish |
34 |
34 |
$487.68 |
| D0272 |
Bitewings - two radiographic images |
21 |
21 |
$387.79 |
| D0602 |
|
40 |
40 |
$356.85 |
| D0210 |
Intraoral - complete series of radiographic images |
33 |
18 |
$355.77 |