| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,484 |
847 |
$196K |
| D1110 |
Prophylaxis - adult |
3,025 |
2,869 |
$152K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,795 |
4,631 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,054 |
1,935 |
$114K |
| D0274 |
Bitewings - four radiographic images |
3,240 |
3,027 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
3,455 |
3,259 |
$97K |
| D0220 |
Intraoral - periapical first radiographic image |
5,920 |
5,427 |
$84K |
| D0330 |
Panoramic radiographic image |
1,092 |
1,046 |
$71K |
| D0350 |
|
7,256 |
1,063 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
927 |
507 |
$52K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
964 |
574 |
$51K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
307 |
79 |
$51K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
267 |
187 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
672 |
228 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,433 |
2,301 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
822 |
763 |
$38K |
| D1120 |
Prophylaxis - child |
1,358 |
1,308 |
$37K |
| D2140 |
|
500 |
299 |
$19K |
| D2160 |
|
224 |
159 |
$14K |
| D1351 |
Sealant - per tooth |
432 |
132 |
$10K |
| D2335 |
|
96 |
59 |
$9K |
| D0272 |
Bitewings - two radiographic images |
840 |
818 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
55 |
54 |
$7K |
| D2331 |
|
34 |
18 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
94 |
88 |
$2K |
| D2330 |
|
20 |
12 |
$829.16 |
| D2332 |
|
14 |
12 |
$704.90 |
| D0180 |
|
30 |
26 |
$690.38 |