| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
8,812 |
5,019 |
$926K |
| D0120 |
Periodic oral evaluation - established patient |
18,985 |
18,335 |
$466K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,814 |
2,964 |
$376K |
| D7140 |
Extraction, erupted tooth or exposed root |
5,931 |
3,042 |
$367K |
| D0330 |
Panoramic radiographic image |
7,499 |
6,946 |
$364K |
| D1110 |
Prophylaxis - adult |
9,784 |
9,366 |
$359K |
| D0274 |
Bitewings - four radiographic images |
10,779 |
10,123 |
$324K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,533 |
1,755 |
$323K |
| D0220 |
Intraoral - periapical first radiographic image |
19,892 |
18,605 |
$285K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,532 |
1,230 |
$254K |
| D0230 |
Intraoral - periapical each additional radiographic image |
20,346 |
16,346 |
$236K |
| D1208 |
Topical application of fluoride, excluding varnish |
14,354 |
13,715 |
$227K |
| D1120 |
Prophylaxis - child |
8,126 |
7,808 |
$215K |
| D4355 |
|
3,386 |
3,189 |
$208K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,960 |
5,728 |
$206K |
| D0140 |
Limited oral evaluation - problem focused |
3,089 |
2,927 |
$107K |
| D0272 |
Bitewings - two radiographic images |
4,258 |
4,034 |
$75K |
| D1351 |
Sealant - per tooth |
2,828 |
584 |
$70K |
| D2335 |
|
542 |
338 |
$64K |
| D4341 |
|
401 |
162 |
$36K |
| D7250 |
|
309 |
123 |
$30K |
| D2331 |
|
347 |
210 |
$25K |
| D0160 |
|
248 |
222 |
$17K |
| D2330 |
|
208 |
133 |
$11K |
| D2332 |
|
93 |
51 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
61 |
53 |
$3K |