| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
7,587 |
3,007 |
$503K |
| D0120 |
Periodic oral evaluation - established patient |
6,125 |
6,109 |
$355K |
| D0230 |
Intraoral - periapical each additional radiographic image |
59,653 |
11,525 |
$252K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,640 |
1,947 |
$250K |
| D1120 |
Prophylaxis - child |
5,621 |
5,609 |
$216K |
| D1110 |
Prophylaxis - adult |
2,225 |
2,218 |
$185K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,729 |
2,722 |
$171K |
| D0274 |
Bitewings - four radiographic images |
6,923 |
6,907 |
$146K |
| D0350 |
|
12,923 |
4,063 |
$118K |
| D1206 |
Topical application of fluoride varnish |
8,445 |
8,421 |
$115K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
869 |
469 |
$68K |
| D0220 |
Intraoral - periapical first radiographic image |
5,683 |
5,213 |
$68K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,153 |
571 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
707 |
652 |
$27K |
| D7240 |
Removal of impacted tooth - completely bony |
109 |
42 |
$25K |
| D9430 |
|
781 |
743 |
$24K |
| D4341 |
|
323 |
85 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
424 |
423 |
$18K |
| D0330 |
Panoramic radiographic image |
580 |
579 |
$17K |
| D4910 |
|
209 |
209 |
$16K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
25 |
25 |
$12K |
| D1310 |
|
248 |
247 |
$11K |
| D0272 |
Bitewings - two radiographic images |
772 |
770 |
$9K |
| D2954 |
|
82 |
66 |
$9K |
| D9993 |
|
130 |
129 |
$8K |
| D2740 |
Crown - porcelain/ceramic |
15 |
13 |
$7K |
| D1351 |
Sealant - per tooth |
194 |
48 |
$6K |
| D2332 |
|
28 |
13 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
156 |
156 |
$2K |
| D2330 |
|
19 |
13 |
$1K |
| D0601 |
|
78 |
78 |
$1K |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
24 |
$904.00 |
| D0240 |
|
25 |
13 |
$220.00 |