| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,347 |
985 |
$266K |
| D2394 |
|
1,548 |
726 |
$208K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
874 |
353 |
$79K |
| D1120 |
Prophylaxis - child |
2,837 |
2,319 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
2,116 |
1,722 |
$64K |
| D0330 |
Panoramic radiographic image |
1,487 |
1,326 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,961 |
1,516 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
606 |
359 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,425 |
1,957 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,078 |
1,442 |
$40K |
| D1206 |
Topical application of fluoride varnish |
1,693 |
1,427 |
$33K |
| D0220 |
Intraoral - periapical first radiographic image |
2,918 |
2,052 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,030 |
1,221 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
749 |
647 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
936 |
683 |
$11K |
| D1351 |
Sealant - per tooth |
455 |
114 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
40 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
80 |
37 |
$5K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
24 |
12 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
18 |
17 |
$1K |