| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
9,933 |
3,299 |
$594K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,874 |
1,915 |
$262K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,116 |
2,272 |
$247K |
| D1110 |
Prophylaxis - adult |
4,518 |
4,262 |
$166K |
| D0274 |
Bitewings - four radiographic images |
6,026 |
5,696 |
$130K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,435 |
4,178 |
$124K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
240 |
229 |
$102K |
| D0120 |
Periodic oral evaluation - established patient |
5,321 |
5,032 |
$98K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,327 |
822 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
1,462 |
1,368 |
$81K |
| D2331 |
|
963 |
416 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,627 |
3,421 |
$58K |
| D1120 |
Prophylaxis - child |
2,298 |
2,185 |
$49K |
| D0330 |
Panoramic radiographic image |
1,178 |
1,136 |
$39K |
| D7230 |
|
242 |
176 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,831 |
1,742 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
847 |
754 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
3,078 |
2,766 |
$16K |
| D3320 |
|
27 |
26 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
172 |
97 |
$9K |
| D2752 |
|
20 |
13 |
$6K |
| D2140 |
|
123 |
58 |
$5K |
| D3310 |
|
17 |
14 |
$4K |
| D2332 |
|
49 |
26 |
$4K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
548 |
253 |
$3K |
| D0340 |
|
16 |
13 |
$960.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
51 |
47 |
$875.00 |
| D0470 |
|
35 |
32 |
$770.70 |
| D2330 |
|
15 |
13 |
$768.15 |
| D0350 |
|
16 |
13 |
$196.96 |