| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,020 |
1,525 |
$226K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,721 |
1,687 |
$218K |
| D1110 |
Prophylaxis - adult |
3,036 |
2,881 |
$110K |
| D0274 |
Bitewings - four radiographic images |
3,312 |
3,172 |
$101K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,053 |
710 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,910 |
2,036 |
$87K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,196 |
3,061 |
$68K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,272 |
434 |
$68K |
| D2332 |
|
657 |
365 |
$66K |
| D7140 |
Extraction, erupted tooth or exposed root |
909 |
290 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
4,211 |
3,887 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
2,079 |
1,996 |
$48K |
| D2330 |
|
810 |
429 |
$47K |
| D7250 |
|
465 |
110 |
$39K |
| D1120 |
Prophylaxis - child |
879 |
870 |
$39K |
| D0140 |
Limited oral evaluation - problem focused |
1,312 |
1,174 |
$35K |
| D2331 |
|
360 |
232 |
$30K |
| D0330 |
Panoramic radiographic image |
941 |
525 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
845 |
836 |
$23K |
| D1351 |
Sealant - per tooth |
591 |
145 |
$22K |
| D2335 |
|
155 |
102 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
276 |
253 |
$15K |
| D2950 |
|
179 |
72 |
$7K |
| D9310 |
|
248 |
230 |
$5K |
| D7230 |
|
25 |
14 |
$4K |
| D2394 |
|
32 |
27 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$507.60 |