| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,106 |
3,118 |
$371K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
5,276 |
2,944 |
$304K |
| D4341 |
|
6,463 |
2,556 |
$259K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,548 |
5,253 |
$216K |
| D1110 |
Prophylaxis - adult |
3,491 |
3,385 |
$202K |
| D0140 |
Limited oral evaluation - problem focused |
5,476 |
5,158 |
$165K |
| D0330 |
Panoramic radiographic image |
3,747 |
3,598 |
$154K |
| D1206 |
Topical application of fluoride varnish |
6,029 |
5,591 |
$122K |
| D0220 |
Intraoral - periapical first radiographic image |
8,980 |
8,467 |
$93K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
944 |
652 |
$84K |
| D0274 |
Bitewings - four radiographic images |
5,907 |
5,706 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
1,424 |
1,412 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13,270 |
6,506 |
$32K |
| D4346 |
|
503 |
487 |
$31K |
| D9110 |
|
302 |
296 |
$20K |
| D1999 |
|
1,988 |
1,313 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
170 |
68 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
319 |
274 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
304 |
242 |
$7K |
| D2330 |
|
54 |
31 |
$3K |
| D1120 |
Prophylaxis - child |
130 |
120 |
$3K |
| D2332 |
|
15 |
14 |
$2K |
| D4910 |
|
14 |
14 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
51 |
48 |
$657.37 |
| D4342 |
|
25 |
16 |
$620.71 |