| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,113 |
1,180 |
$107K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,132 |
517 |
$73K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,096 |
726 |
$70K |
| D1110 |
Prophylaxis - adult |
1,601 |
1,460 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
2,754 |
2,505 |
$48K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,021 |
592 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,251 |
2,034 |
$35K |
| D0140 |
Limited oral evaluation - problem focused |
1,122 |
1,016 |
$33K |
| D1120 |
Prophylaxis - child |
1,324 |
1,207 |
$30K |
| D2335 |
|
241 |
109 |
$29K |
| D0274 |
Bitewings - four radiographic images |
1,114 |
1,018 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
507 |
486 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,347 |
1,142 |
$26K |
| D0330 |
Panoramic radiographic image |
810 |
725 |
$26K |
| D2394 |
|
210 |
148 |
$20K |
| D1351 |
Sealant - per tooth |
1,550 |
318 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
657 |
598 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
1,186 |
1,084 |
$12K |
| D0272 |
Bitewings - two radiographic images |
514 |
458 |
$7K |
| D2332 |
|
25 |
13 |
$2K |
| D2331 |
|
22 |
16 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
46 |
26 |
$250.00 |