| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,144 |
1,375 |
$209K |
| D0120 |
Periodic oral evaluation - established patient |
2,905 |
2,887 |
$171K |
| D2740 |
Crown - porcelain/ceramic |
273 |
169 |
$130K |
| D1120 |
Prophylaxis - child |
3,034 |
3,019 |
$122K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,769 |
1,764 |
$116K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,230 |
620 |
$98K |
| D1110 |
Prophylaxis - adult |
1,090 |
1,084 |
$96K |
| D0210 |
Intraoral - complete series of radiographic images |
1,688 |
1,677 |
$79K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,338 |
4,314 |
$58K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,210 |
3,198 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
694 |
377 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,781 |
1,766 |
$37K |
| D1351 |
Sealant - per tooth |
804 |
263 |
$26K |
| D2954 |
|
238 |
150 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
457 |
252 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
1,373 |
1,360 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
133 |
81 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
27 |
24 |
$13K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
217 |
204 |
$9K |
| D0350 |
|
627 |
332 |
$5K |
| D4341 |
|
63 |
25 |
$4K |
| D7111 |
|
25 |
12 |
$1K |
| D4910 |
|
12 |
12 |
$924.00 |
| D0272 |
Bitewings - two radiographic images |
74 |
74 |
$740.00 |
| D9430 |
|
13 |
13 |
$416.00 |