| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,233 |
1,024 |
$168K |
| D1110 |
Prophylaxis - adult |
3,671 |
2,959 |
$141K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,491 |
705 |
$130K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
956 |
387 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,551 |
2,182 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,551 |
1,094 |
$51K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
849 |
614 |
$26K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
441 |
233 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,003 |
936 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,829 |
1,262 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
408 |
268 |
$13K |
| D0274 |
Bitewings - four radiographic images |
772 |
541 |
$12K |
| D0330 |
Panoramic radiographic image |
381 |
289 |
$11K |
| D2394 |
|
104 |
66 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
63 |
13 |
$3K |
| D1120 |
Prophylaxis - child |
45 |
45 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
35 |
31 |
$1K |
| D3110 |
|
141 |
68 |
$919.28 |
| D0230 |
Intraoral - periapical each additional radiographic image |
191 |
103 |
$854.15 |
| D9110 |
|
106 |
66 |
$854.09 |
| D1208 |
Topical application of fluoride, excluding varnish |
16 |
16 |
$316.32 |
| D1999 |
|
44 |
39 |
$0.00 |