| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,023 |
1,299 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,547 |
1,535 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
1,692 |
1,649 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
843 |
838 |
$4K |
| D1110 |
Prophylaxis - adult |
1,618 |
1,609 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
931 |
625 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
429 |
346 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
3,201 |
3,053 |
$3K |
| D0274 |
Bitewings - four radiographic images |
1,585 |
1,564 |
$2K |
| D1206 |
Topical application of fluoride varnish |
2,182 |
2,153 |
$2K |
| D4910 |
|
531 |
529 |
$2K |
| D2332 |
|
127 |
88 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
1,400 |
1,366 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,975 |
2,026 |
$2K |
| D4341 |
|
161 |
85 |
$630.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
13 |
$320.00 |
| D0330 |
Panoramic radiographic image |
165 |
162 |
$260.00 |
| D0603 |
|
978 |
960 |
$225.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
26 |
$182.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
14 |
$110.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
44 |
44 |
$95.00 |
| D0602 |
|
307 |
299 |
$60.00 |
| D0270 |
|
126 |
124 |
$44.00 |
| D8660 |
|
157 |
155 |
$0.00 |
| D4921 |
|
182 |
86 |
$0.00 |
| D0601 |
|
18 |
18 |
$0.00 |
| D1330 |
|
27 |
27 |
$0.00 |
| D2335 |
|
21 |
12 |
$0.00 |