| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,320 |
1,864 |
$452K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,907 |
936 |
$279K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,307 |
295 |
$156K |
| D1110 |
Prophylaxis - adult |
2,992 |
2,927 |
$134K |
| D0274 |
Bitewings - four radiographic images |
3,729 |
3,672 |
$112K |
| D0220 |
Intraoral - periapical first radiographic image |
7,192 |
6,931 |
$108K |
| D0330 |
Panoramic radiographic image |
1,879 |
1,836 |
$92K |
| D1206 |
Topical application of fluoride varnish |
5,155 |
5,041 |
$85K |
| D1120 |
Prophylaxis - child |
2,304 |
2,253 |
$68K |
| D0120 |
Periodic oral evaluation - established patient |
3,232 |
3,171 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,171 |
2,092 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,402 |
5,848 |
$48K |
| D7960 |
|
260 |
164 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
655 |
410 |
$39K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
504 |
453 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
294 |
290 |
$9K |
| 40819 |
|
30 |
29 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
141 |
134 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
173 |
173 |
$5K |
| D2394 |
|
21 |
12 |
$4K |
| D0601 |
|
371 |
371 |
$3K |
| D2335 |
|
25 |
12 |
$3K |
| D2331 |
|
16 |
13 |
$2K |
| D0603 |
|
160 |
160 |
$1K |
| D0602 |
|
57 |
57 |
$503.25 |