| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,747 |
2,031 |
$353K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,116 |
1,228 |
$262K |
| D1120 |
Prophylaxis - child |
6,058 |
6,029 |
$175K |
| D1110 |
Prophylaxis - adult |
3,644 |
3,630 |
$156K |
| D0330 |
Panoramic radiographic image |
3,248 |
3,226 |
$151K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,211 |
353 |
$138K |
| D0120 |
Periodic oral evaluation - established patient |
6,146 |
6,125 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
8,119 |
7,999 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,719 |
3,696 |
$108K |
| D1206 |
Topical application of fluoride varnish |
6,713 |
6,669 |
$107K |
| D1354 |
|
1,141 |
142 |
$85K |
| D0274 |
Bitewings - four radiographic images |
2,794 |
2,779 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,681 |
6,486 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
883 |
441 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
1,806 |
1,788 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,295 |
3,295 |
$46K |
| D0272 |
Bitewings - two radiographic images |
2,496 |
2,481 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
647 |
418 |
$36K |
| D0350 |
|
648 |
639 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
687 |
646 |
$18K |
| D1351 |
Sealant - per tooth |
531 |
141 |
$12K |
| D2394 |
|
64 |
41 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
75 |
75 |
$2K |
| D3120 |
|
29 |
15 |
$648.60 |
| D4910 |
|
12 |
12 |
$600.26 |
| D0603 |
|
42 |
42 |
$384.30 |
| D0601 |
|
12 |
12 |
$109.80 |