| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
900 |
403 |
$87K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
535 |
252 |
$53K |
| D7140 |
Extraction, erupted tooth or exposed root |
676 |
248 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,533 |
955 |
$38K |
| D1110 |
Prophylaxis - adult |
885 |
874 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
1,239 |
1,223 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
296 |
179 |
$21K |
| D0330 |
Panoramic radiographic image |
391 |
374 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
160 |
114 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,185 |
1,123 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
488 |
465 |
$15K |
| D1120 |
Prophylaxis - child |
505 |
493 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
492 |
481 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
188 |
178 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
191 |
183 |
$7K |
| D2332 |
|
78 |
40 |
$7K |
| D1206 |
Topical application of fluoride varnish |
337 |
327 |
$5K |
| D0170 |
|
192 |
184 |
$5K |
| D7311 |
|
103 |
37 |
$4K |
| D0272 |
Bitewings - two radiographic images |
33 |
30 |
$471.93 |