| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,000 |
1,749 |
$529K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,340 |
1,751 |
$465K |
| D2394 |
|
2,293 |
875 |
$284K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,407 |
515 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,164 |
1,819 |
$72K |
| D1110 |
Prophylaxis - adult |
2,104 |
1,780 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
1,206 |
973 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,978 |
1,628 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
2,218 |
1,875 |
$44K |
| D2335 |
|
428 |
133 |
$41K |
| D0220 |
Intraoral - periapical first radiographic image |
2,772 |
2,060 |
$32K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
707 |
518 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,479 |
1,313 |
$21K |
| D1120 |
Prophylaxis - child |
780 |
697 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,966 |
599 |
$15K |
| D0274 |
Bitewings - four radiographic images |
802 |
674 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
149 |
64 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
88 |
37 |
$5K |
| D2331 |
|
59 |
27 |
$3K |
| D0170 |
|
64 |
39 |
$1K |
| D1330 |
|
114 |
98 |
$0.00 |
| D1310 |
|
14 |
13 |
$0.00 |