| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,718 |
1,559 |
$149K |
| D1110 |
Prophylaxis - adult |
3,843 |
3,545 |
$143K |
| D0120 |
Periodic oral evaluation - established patient |
6,584 |
6,042 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,199 |
705 |
$85K |
| D1120 |
Prophylaxis - child |
3,364 |
3,069 |
$78K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,965 |
4,497 |
$77K |
| D0274 |
Bitewings - four radiographic images |
2,214 |
2,030 |
$62K |
| D0210 |
Intraoral - complete series of radiographic images |
2,029 |
1,740 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,930 |
1,773 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,703 |
1,574 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,259 |
797 |
$47K |
| D0330 |
Panoramic radiographic image |
1,329 |
1,212 |
$44K |
| D2931 |
|
147 |
104 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,715 |
1,533 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,175 |
1,021 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,541 |
2,235 |
$22K |
| D2332 |
|
138 |
89 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
87 |
41 |
$6K |
| D2394 |
|
99 |
80 |
$6K |
| D2335 |
|
42 |
15 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
395 |
213 |
$3K |
| D1351 |
Sealant - per tooth |
45 |
12 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
122 |
73 |
$1K |
| D2330 |
|
35 |
20 |
$393.08 |