| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,680 |
914 |
$195K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,709 |
995 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
5,756 |
5,452 |
$141K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,081 |
2,489 |
$118K |
| D1110 |
Prophylaxis - adult |
3,121 |
2,940 |
$111K |
| D1120 |
Prophylaxis - child |
3,559 |
3,351 |
$92K |
| D1206 |
Topical application of fluoride varnish |
6,016 |
5,538 |
$90K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,284 |
4,568 |
$90K |
| D0330 |
Panoramic radiographic image |
1,716 |
1,560 |
$81K |
| D0274 |
Bitewings - four radiographic images |
2,641 |
2,442 |
$76K |
| D0220 |
Intraoral - periapical first radiographic image |
5,416 |
4,953 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
1,509 |
1,341 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,136 |
1,032 |
$42K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
577 |
306 |
$36K |
| D4355 |
|
578 |
537 |
$35K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
423 |
80 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,551 |
1,458 |
$27K |
| D7140 |
Extraction, erupted tooth or exposed root |
342 |
192 |
$19K |
| D1351 |
Sealant - per tooth |
448 |
117 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
64 |
37 |
$4K |
| D4346 |
|
77 |
67 |
$2K |