| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,497 |
3,102 |
$429K |
| D1110 |
Prophylaxis - adult |
6,445 |
6,158 |
$319K |
| D7140 |
Extraction, erupted tooth or exposed root |
3,446 |
1,650 |
$292K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,320 |
1,575 |
$221K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,350 |
4,997 |
$204K |
| D0120 |
Periodic oral evaluation - established patient |
7,053 |
6,739 |
$165K |
| D0140 |
Limited oral evaluation - problem focused |
4,460 |
4,096 |
$162K |
| D0274 |
Bitewings - four radiographic images |
4,604 |
4,354 |
$156K |
| D0210 |
Intraoral - complete series of radiographic images |
3,030 |
2,448 |
$149K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,476 |
1,672 |
$141K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
777 |
554 |
$133K |
| D1206 |
Topical application of fluoride varnish |
5,825 |
5,548 |
$123K |
| D1120 |
Prophylaxis - child |
3,086 |
2,932 |
$102K |
| D0330 |
Panoramic radiographic image |
1,807 |
1,646 |
$96K |
| D1351 |
Sealant - per tooth |
2,685 |
362 |
$71K |
| D2331 |
|
617 |
438 |
$64K |
| D0220 |
Intraoral - periapical first radiographic image |
4,099 |
3,640 |
$48K |
| D4346 |
|
312 |
290 |
$48K |
| D0272 |
Bitewings - two radiographic images |
1,779 |
1,695 |
$41K |
| D2335 |
|
156 |
99 |
$26K |
| D2332 |
|
195 |
134 |
$22K |
| D2330 |
|
190 |
110 |
$14K |
| D2394 |
|
91 |
74 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
386 |
347 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,104 |
760 |
$10K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
63 |
43 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
90 |
52 |
$8K |