| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,172 |
1,430 |
$287K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,321 |
755 |
$131K |
| D1110 |
Prophylaxis - adult |
2,904 |
2,874 |
$130K |
| D1351 |
Sealant - per tooth |
4,229 |
780 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
2,912 |
2,882 |
$77K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
591 |
263 |
$68K |
| D2332 |
|
722 |
402 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,976 |
1,968 |
$63K |
| D2740 |
Crown - porcelain/ceramic |
99 |
60 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,693 |
1,680 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
797 |
480 |
$51K |
| D0330 |
Panoramic radiographic image |
1,164 |
1,160 |
$49K |
| D1120 |
Prophylaxis - child |
1,320 |
1,311 |
$47K |
| D0210 |
Intraoral - complete series of radiographic images |
782 |
781 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,709 |
1,701 |
$33K |
| D7140 |
Extraction, erupted tooth or exposed root |
349 |
134 |
$26K |
| D2335 |
|
241 |
116 |
$24K |
| D2394 |
|
178 |
115 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,893 |
1,853 |
$20K |
| D1310 |
|
1,240 |
1,226 |
$16K |
| D9110 |
|
472 |
463 |
$15K |
| D1330 |
|
2,098 |
2,083 |
$14K |
| D0272 |
Bitewings - two radiographic images |
612 |
605 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
347 |
333 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
518 |
511 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,129 |
1,064 |
$9K |
| D2954 |
|
47 |
28 |
$8K |
| D5213 |
|
12 |
12 |
$6K |
| D0603 |
|
658 |
658 |
$4K |
| D0270 |
|
291 |
291 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
106 |
99 |
$4K |
| D0601 |
|
353 |
351 |
$2K |
| D0602 |
|
44 |
44 |
$270.00 |
| D0240 |
|
13 |
12 |
$241.20 |
| D1320 |
|
13 |
13 |
$195.00 |
| D1999 |
|
25 |
23 |
$0.00 |