| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,080 |
975 |
$136K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,134 |
1,371 |
$124K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,433 |
709 |
$44K |
| D1110 |
Prophylaxis - adult |
1,699 |
1,613 |
$35K |
| D0210 |
Intraoral - complete series of radiographic images |
947 |
882 |
$32K |
| D1120 |
Prophylaxis - child |
1,843 |
1,698 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,463 |
3,234 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
2,650 |
2,470 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
974 |
960 |
$19K |
| D0274 |
Bitewings - four radiographic images |
1,569 |
1,460 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
769 |
729 |
$12K |
| D0272 |
Bitewings - two radiographic images |
1,356 |
1,175 |
$10K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
587 |
480 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,348 |
1,245 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
449 |
247 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
226 |
121 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
608 |
546 |
$3K |
| D1351 |
Sealant - per tooth |
198 |
92 |
$597.54 |
| D0330 |
Panoramic radiographic image |
478 |
324 |
$339.64 |
| D2752 |
|
244 |
168 |
$0.00 |
| D4910 |
|
102 |
102 |
$0.00 |
| D2950 |
|
228 |
163 |
$0.00 |
| D2332 |
|
50 |
18 |
$0.00 |