| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,290 |
1,967 |
$401K |
| D0210 |
Intraoral - complete series of radiographic images |
2,784 |
2,364 |
$159K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
939 |
433 |
$154K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,425 |
1,043 |
$146K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,528 |
803 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,917 |
2,612 |
$111K |
| D1110 |
Prophylaxis - adult |
2,224 |
2,030 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
1,912 |
1,779 |
$46K |
| D1120 |
Prophylaxis - child |
1,385 |
1,281 |
$46K |
| D1351 |
Sealant - per tooth |
1,403 |
258 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,570 |
1,447 |
$33K |
| D0274 |
Bitewings - four radiographic images |
999 |
916 |
$32K |
| D0330 |
Panoramic radiographic image |
604 |
538 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
631 |
574 |
$21K |
| D2394 |
|
96 |
54 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
716 |
561 |
$7K |
| D7250 |
|
36 |
16 |
$5K |
| D4342 |
|
73 |
16 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
90 |
89 |
$2K |
| D1352 |
|
39 |
12 |
$2K |
| D4346 |
|
16 |
13 |
$2K |
| D7111 |
|
17 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21 |
15 |
$649.95 |
| D0145 |
Oral evaluation for a patient under three years of age |
16 |
13 |
$213.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
18 |
$90.00 |