| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,769 |
4,415 |
$524K |
| D1110 |
Prophylaxis - adult |
9,355 |
9,239 |
$419K |
| D9630 |
|
14,250 |
13,970 |
$322K |
| D0120 |
Periodic oral evaluation - established patient |
12,791 |
12,654 |
$284K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
8,449 |
7,566 |
$250K |
| D1208 |
Topical application of fluoride, excluding varnish |
12,119 |
12,010 |
$247K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,264 |
1,558 |
$210K |
| D0330 |
Panoramic radiographic image |
4,612 |
3,898 |
$196K |
| D1120 |
Prophylaxis - child |
5,506 |
5,471 |
$184K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,052 |
1,093 |
$184K |
| D0274 |
Bitewings - four radiographic images |
6,636 |
6,561 |
$157K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,696 |
1,345 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,391 |
3,661 |
$110K |
| D0220 |
Intraoral - periapical first radiographic image |
10,541 |
9,370 |
$108K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,609 |
4,116 |
$87K |
| D1351 |
Sealant - per tooth |
1,144 |
402 |
$36K |
| D1206 |
Topical application of fluoride varnish |
1,366 |
1,364 |
$29K |
| D2332 |
|
265 |
142 |
$27K |
| D2740 |
Crown - porcelain/ceramic |
48 |
26 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
1,812 |
821 |
$21K |
| D9248 |
|
190 |
160 |
$17K |
| D0272 |
Bitewings - two radiographic images |
641 |
632 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
321 |
247 |
$6K |
| D2394 |
|
49 |
39 |
$5K |
| D2335 |
|
27 |
12 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
22 |
14 |
$2K |
| D1353 |
|
27 |
13 |
$87.90 |
| D0603 |
|
33 |
32 |
$0.00 |