| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,737 |
2,129 |
$317K |
| D1110 |
Prophylaxis - adult |
9,981 |
8,270 |
$298K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,550 |
6,741 |
$279K |
| D0120 |
Periodic oral evaluation - established patient |
11,242 |
9,650 |
$242K |
| D1120 |
Prophylaxis - child |
8,169 |
6,778 |
$182K |
| D0330 |
Panoramic radiographic image |
4,164 |
3,431 |
$166K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,398 |
1,382 |
$154K |
| D1206 |
Topical application of fluoride varnish |
11,208 |
9,229 |
$148K |
| D0274 |
Bitewings - four radiographic images |
6,081 |
5,060 |
$147K |
| D0140 |
Limited oral evaluation - problem focused |
4,879 |
3,985 |
$143K |
| D0220 |
Intraoral - periapical first radiographic image |
9,881 |
8,084 |
$112K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,599 |
641 |
$86K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,297 |
4,732 |
$61K |
| D1351 |
Sealant - per tooth |
2,461 |
505 |
$53K |
| D0272 |
Bitewings - two radiographic images |
2,430 |
1,984 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
282 |
205 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
563 |
425 |
$28K |
| D7250 |
|
188 |
51 |
$20K |
| D4341 |
|
221 |
97 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
201 |
109 |
$16K |
| D2335 |
|
140 |
81 |
$13K |
| D2332 |
|
81 |
49 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
153 |
131 |
$6K |
| D4342 |
|
214 |
67 |
$6K |
| D2331 |
|
48 |
31 |
$4K |
| D4355 |
|
76 |
55 |
$3K |
| D2330 |
|
56 |
35 |
$2K |
| D2394 |
|
17 |
14 |
$2K |