| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,695 |
2,822 |
$279K |
| D9248 |
|
5,334 |
3,707 |
$194K |
| D0120 |
Periodic oral evaluation - established patient |
9,238 |
8,625 |
$175K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,266 |
1,542 |
$167K |
| D0272 |
Bitewings - two radiographic images |
7,783 |
7,283 |
$159K |
| D1120 |
Prophylaxis - child |
5,108 |
4,764 |
$148K |
| D1206 |
Topical application of fluoride varnish |
7,869 |
7,334 |
$144K |
| D1110 |
Prophylaxis - adult |
3,425 |
3,165 |
$135K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,122 |
1,161 |
$94K |
| D7140 |
Extraction, erupted tooth or exposed root |
931 |
496 |
$77K |
| D0330 |
Panoramic radiographic image |
568 |
498 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
677 |
642 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
1,914 |
1,762 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,842 |
1,373 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
355 |
331 |
$10K |
| D9920 |
|
175 |
135 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,690 |
3,631 |
$4K |
| D1517 |
|
12 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
104 |
$3K |
| D1510 |
|
24 |
13 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
16 |
12 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$457.95 |
| D9610 |
|
18 |
12 |
$0.00 |
| D9215 |
|
5,788 |
4,524 |
$0.00 |