| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,541 |
642 |
$253K |
| D1110 |
Prophylaxis - adult |
1,579 |
1,436 |
$124K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
524 |
329 |
$111K |
| D2740 |
Crown - porcelain/ceramic |
131 |
88 |
$94K |
| D0210 |
Intraoral - complete series of radiographic images |
1,064 |
935 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,444 |
1,244 |
$81K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
323 |
106 |
$69K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,413 |
1,078 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
718 |
653 |
$43K |
| D7140 |
Extraction, erupted tooth or exposed root |
210 |
38 |
$27K |
| D1206 |
Topical application of fluoride varnish |
846 |
820 |
$23K |
| D0274 |
Bitewings - four radiographic images |
375 |
373 |
$22K |
| D0330 |
Panoramic radiographic image |
298 |
220 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
402 |
397 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
816 |
694 |
$18K |
| D2950 |
|
100 |
80 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
36 |
27 |
$5K |
| D1120 |
Prophylaxis - child |
44 |
42 |
$3K |
| D2331 |
|
16 |
12 |
$2K |
| D0272 |
Bitewings - two radiographic images |
25 |
24 |
$977.28 |