| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,964 |
1,887 |
$284K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,663 |
7,612 |
$266K |
| D1120 |
Prophylaxis - child |
6,493 |
6,467 |
$206K |
| D0274 |
Bitewings - four radiographic images |
6,203 |
6,157 |
$168K |
| D4346 |
|
1,115 |
1,110 |
$134K |
| D0210 |
Intraoral - complete series of radiographic images |
2,308 |
2,244 |
$129K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,151 |
6,125 |
$111K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,815 |
6,857 |
$106K |
| D0220 |
Intraoral - periapical first radiographic image |
8,308 |
8,196 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,613 |
848 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
859 |
557 |
$74K |
| D1206 |
Topical application of fluoride varnish |
3,654 |
3,633 |
$67K |
| D1110 |
Prophylaxis - adult |
1,510 |
1,502 |
$67K |
| D0120 |
Periodic oral evaluation - established patient |
2,975 |
2,966 |
$66K |
| D1351 |
Sealant - per tooth |
2,505 |
688 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
663 |
320 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
1,138 |
1,114 |
$32K |
| D4341 |
|
208 |
77 |
$25K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
187 |
59 |
$20K |
| D2394 |
|
175 |
129 |
$18K |
| D0272 |
Bitewings - two radiographic images |
849 |
843 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
642 |
605 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
120 |
69 |
$13K |
| D0330 |
Panoramic radiographic image |
213 |
204 |
$8K |
| D2331 |
|
82 |
46 |
$7K |
| D8660 |
|
58 |
58 |
$6K |
| D9243 |
|
16 |
12 |
$2K |
| D7510 |
|
13 |
12 |
$2K |
| D2332 |
|
16 |
12 |
$2K |
| D0270 |
|
166 |
164 |
$2K |
| D2330 |
|
23 |
12 |
$2K |
| D9239 |
|
12 |
12 |
$1K |
| D9110 |
|
13 |
13 |
$730.67 |
| D0603 |
|
205 |
201 |
$0.00 |
| D0602 |
|
23 |
23 |
$0.00 |