| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2720 |
|
383 |
149 |
$280K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
733 |
257 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
438 |
109 |
$44K |
| D0330 |
Panoramic radiographic image |
490 |
329 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
278 |
69 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
395 |
171 |
$22K |
| D1110 |
Prophylaxis - adult |
436 |
286 |
$21K |
| D2950 |
|
141 |
77 |
$19K |
| D0274 |
Bitewings - four radiographic images |
627 |
414 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
484 |
323 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
586 |
388 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
176 |
80 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
398 |
263 |
$13K |
| D1120 |
Prophylaxis - child |
302 |
209 |
$10K |
| D1330 |
|
479 |
312 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
569 |
369 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
316 |
219 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
733 |
257 |
$7K |
| D2331 |
|
57 |
30 |
$6K |
| D1206 |
Topical application of fluoride varnish |
228 |
149 |
$6K |
| D0272 |
Bitewings - two radiographic images |
116 |
71 |
$3K |
| D4910 |
|
35 |
25 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
87 |
51 |
$1K |
| D0270 |
|
168 |
115 |
$1K |