| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,740 |
3,877 |
$684K |
| D1110 |
Prophylaxis - adult |
11,500 |
10,878 |
$414K |
| D0120 |
Periodic oral evaluation - established patient |
15,804 |
14,944 |
$389K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,361 |
1,294 |
$253K |
| D0274 |
Bitewings - four radiographic images |
8,541 |
8,041 |
$252K |
| D0220 |
Intraoral - periapical first radiographic image |
17,184 |
16,028 |
$242K |
| D0330 |
Panoramic radiographic image |
4,369 |
4,094 |
$206K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,405 |
4,126 |
$180K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,358 |
1,560 |
$180K |
| D0230 |
Intraoral - periapical each additional radiographic image |
15,211 |
13,265 |
$177K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,388 |
985 |
$173K |
| D1120 |
Prophylaxis - child |
5,140 |
4,884 |
$136K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,019 |
6,824 |
$116K |
| D0140 |
Limited oral evaluation - problem focused |
3,125 |
2,921 |
$107K |
| D1206 |
Topical application of fluoride varnish |
3,432 |
3,122 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,419 |
2,300 |
$41K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
385 |
173 |
$39K |
| D4341 |
|
238 |
111 |
$19K |
| D1351 |
Sealant - per tooth |
396 |
93 |
$10K |
| D2332 |
|
63 |
42 |
$5K |
| D2331 |
|
71 |
38 |
$4K |
| D4346 |
|
96 |
94 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
83 |
67 |
$3K |
| D2335 |
|
17 |
13 |
$2K |
| D4342 |
|
70 |
25 |
$2K |