| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,759 |
1,827 |
$304K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,272 |
650 |
$282K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,377 |
969 |
$214K |
| D0274 |
Bitewings - four radiographic images |
5,620 |
5,494 |
$166K |
| D0220 |
Intraoral - periapical first radiographic image |
10,990 |
10,531 |
$160K |
| D1110 |
Prophylaxis - adult |
3,652 |
3,545 |
$160K |
| D0330 |
Panoramic radiographic image |
3,246 |
3,151 |
$155K |
| D0120 |
Periodic oral evaluation - established patient |
6,890 |
6,727 |
$140K |
| D1120 |
Prophylaxis - child |
4,624 |
4,530 |
$135K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,036 |
9,702 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,666 |
2,593 |
$80K |
| D1206 |
Topical application of fluoride varnish |
4,121 |
3,933 |
$75K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,241 |
3,241 |
$46K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,486 |
1,336 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
1,105 |
1,084 |
$32K |
| D3120 |
|
146 |
69 |
$4K |
| D0601 |
|
397 |
397 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
24 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
38 |
27 |
$2K |
| D2332 |
|
21 |
13 |
$2K |
| D1351 |
Sealant - per tooth |
68 |
13 |
$2K |
| D0602 |
|
176 |
176 |
$2K |
| D0272 |
Bitewings - two radiographic images |
36 |
36 |
$622.20 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$457.35 |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
17 |
$395.73 |
| D0603 |
|
13 |
13 |
$118.95 |