| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,333 |
1,358 |
$331K |
| D0140 |
Limited oral evaluation - problem focused |
7,082 |
6,219 |
$251K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,061 |
877 |
$196K |
| D1120 |
Prophylaxis - child |
6,528 |
5,730 |
$169K |
| D0330 |
Panoramic radiographic image |
2,562 |
2,335 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,566 |
567 |
$114K |
| D1206 |
Topical application of fluoride varnish |
5,089 |
4,546 |
$112K |
| D0274 |
Bitewings - four radiographic images |
2,732 |
2,469 |
$67K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,162 |
1,729 |
$62K |
| D1351 |
Sealant - per tooth |
1,740 |
244 |
$50K |
| D0120 |
Periodic oral evaluation - established patient |
1,650 |
1,581 |
$47K |
| D7140 |
Extraction, erupted tooth or exposed root |
543 |
307 |
$42K |
| D0220 |
Intraoral - periapical first radiographic image |
3,306 |
2,878 |
$37K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
247 |
141 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
510 |
417 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
69 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
305 |
271 |
$4K |
| D0272 |
Bitewings - two radiographic images |
184 |
168 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
255 |
120 |
$3K |
| D2332 |
|
28 |
14 |
$3K |