| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,133 |
3,217 |
$722K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,732 |
1,578 |
$339K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,853 |
814 |
$186K |
| D0120 |
Periodic oral evaluation - established patient |
7,886 |
7,471 |
$184K |
| D1110 |
Prophylaxis - adult |
3,664 |
3,471 |
$126K |
| D1120 |
Prophylaxis - child |
4,262 |
4,092 |
$110K |
| D0330 |
Panoramic radiographic image |
1,922 |
1,836 |
$104K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,493 |
2,325 |
$103K |
| D0220 |
Intraoral - periapical first radiographic image |
7,172 |
6,658 |
$98K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,238 |
846 |
$94K |
| D0274 |
Bitewings - four radiographic images |
2,948 |
2,806 |
$86K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,476 |
5,195 |
$85K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,758 |
5,824 |
$83K |
| D4355 |
|
980 |
943 |
$61K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,586 |
1,529 |
$60K |
| D1351 |
Sealant - per tooth |
1,945 |
463 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,183 |
2,103 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
602 |
345 |
$38K |
| D2394 |
|
244 |
202 |
$37K |
| D4341 |
|
364 |
157 |
$29K |
| D0140 |
Limited oral evaluation - problem focused |
779 |
762 |
$26K |
| D2332 |
|
185 |
102 |
$17K |
| D1206 |
Topical application of fluoride varnish |
666 |
652 |
$11K |
| D2335 |
|
48 |
30 |
$6K |
| D4342 |
|
88 |
41 |
$4K |
| D2331 |
|
49 |
36 |
$4K |
| D7250 |
|
25 |
13 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
24 |
16 |
$2K |
| D7311 |
|
27 |
12 |
$2K |
| D4346 |
|
32 |
32 |
$1K |
| D1330 |
|
497 |
492 |
$0.00 |