| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,666 |
2,711 |
$548K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,629 |
1,383 |
$312K |
| D0120 |
Periodic oral evaluation - established patient |
8,767 |
8,082 |
$207K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,625 |
1,424 |
$189K |
| D1110 |
Prophylaxis - adult |
4,248 |
3,917 |
$149K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,732 |
3,331 |
$141K |
| D0330 |
Panoramic radiographic image |
3,536 |
3,146 |
$140K |
| D0274 |
Bitewings - four radiographic images |
5,268 |
4,749 |
$138K |
| D1120 |
Prophylaxis - child |
5,242 |
4,775 |
$130K |
| D0220 |
Intraoral - periapical first radiographic image |
9,904 |
8,864 |
$129K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,330 |
7,901 |
$118K |
| D2394 |
|
701 |
399 |
$106K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,980 |
1,716 |
$80K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
835 |
388 |
$80K |
| D1351 |
Sealant - per tooth |
2,988 |
636 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
2,111 |
1,900 |
$69K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,482 |
3,143 |
$52K |
| D1206 |
Topical application of fluoride varnish |
3,358 |
3,100 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,311 |
2,118 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
416 |
203 |
$23K |
| D4346 |
|
520 |
485 |
$18K |
| D4355 |
|
118 |
88 |
$6K |
| D2335 |
|
23 |
12 |
$3K |
| D2332 |
|
23 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
14 |
$785.30 |
| D0270 |
|
31 |
29 |
$232.56 |