| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,900 |
816 |
$140K |
| D0210 |
Intraoral - complete series of radiographic images |
1,415 |
1,335 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
788 |
439 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
753 |
306 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,782 |
1,747 |
$54K |
| D1110 |
Prophylaxis - adult |
667 |
654 |
$25K |
| D0330 |
Panoramic radiographic image |
529 |
518 |
$24K |
| D2950 |
|
159 |
78 |
$23K |
| D0140 |
Limited oral evaluation - problem focused |
822 |
770 |
$19K |
| D2394 |
|
113 |
69 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
147 |
49 |
$13K |
| D2332 |
|
85 |
35 |
$12K |
| D0274 |
Bitewings - four radiographic images |
432 |
430 |
$10K |
| D4342 |
|
74 |
30 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,459 |
496 |
$9K |
| D1206 |
Topical application of fluoride varnish |
461 |
450 |
$8K |
| D2331 |
|
67 |
33 |
$7K |
| D1120 |
Prophylaxis - child |
284 |
279 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
239 |
236 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
772 |
742 |
$5K |
| D2330 |
|
47 |
30 |
$5K |
| D0350 |
|
161 |
122 |
$3K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
52 |
14 |
$3K |
| D0180 |
|
47 |
47 |
$2K |
| D9222 |
|
14 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
39 |
39 |
$350.00 |