| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,700 |
1,491 |
$241K |
| D1110 |
Prophylaxis - adult |
4,565 |
4,534 |
$224K |
| D0120 |
Periodic oral evaluation - established patient |
7,008 |
6,952 |
$196K |
| D1120 |
Prophylaxis - child |
3,797 |
3,792 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,810 |
2,766 |
$131K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
985 |
632 |
$97K |
| D0274 |
Bitewings - four radiographic images |
2,841 |
2,780 |
$70K |
| D0272 |
Bitewings - two radiographic images |
3,171 |
3,160 |
$68K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,266 |
3,263 |
$67K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
581 |
422 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
1,311 |
1,293 |
$65K |
| D0220 |
Intraoral - periapical first radiographic image |
4,666 |
4,556 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,375 |
1,259 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
769 |
423 |
$46K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,104 |
3,122 |
$42K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
454 |
202 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,353 |
1,352 |
$34K |
| D1351 |
Sealant - per tooth |
784 |
266 |
$22K |
| D4341 |
|
252 |
77 |
$22K |
| D2160 |
|
178 |
95 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
57 |
$2K |
| D2394 |
|
17 |
13 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
14 |
12 |
$1K |