| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,849 |
1,446 |
$197K |
| D8670 |
Periodic orthodontic treatment visit |
1,847 |
1,729 |
$133K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,149 |
1,045 |
$122K |
| D1120 |
Prophylaxis - child |
3,308 |
3,181 |
$108K |
| D0120 |
Periodic oral evaluation - established patient |
3,739 |
3,565 |
$87K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,122 |
3,796 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
885 |
557 |
$72K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,116 |
1,824 |
$58K |
| D1110 |
Prophylaxis - adult |
1,259 |
1,204 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
929 |
889 |
$49K |
| D0330 |
Panoramic radiographic image |
915 |
781 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
757 |
731 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
390 |
218 |
$21K |
| D0274 |
Bitewings - four radiographic images |
832 |
721 |
$18K |
| D0272 |
Bitewings - two radiographic images |
1,054 |
995 |
$17K |
| D2791 |
|
26 |
16 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
526 |
487 |
$11K |
| D1206 |
Topical application of fluoride varnish |
562 |
543 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
897 |
852 |
$11K |
| D2950 |
|
86 |
60 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
15 |
$9K |
| D1351 |
Sealant - per tooth |
219 |
67 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
435 |
397 |
$4K |
| D8660 |
|
14 |
14 |
$633.75 |