| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,574 |
1,973 |
$315K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,863 |
974 |
$208K |
| D2394 |
|
1,894 |
1,279 |
$200K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,435 |
1,436 |
$178K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,328 |
4,321 |
$150K |
| D1110 |
Prophylaxis - adult |
3,184 |
3,180 |
$145K |
| D0274 |
Bitewings - four radiographic images |
4,149 |
4,144 |
$121K |
| D0140 |
Limited oral evaluation - problem focused |
2,750 |
2,653 |
$80K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,883 |
3,877 |
$70K |
| D0220 |
Intraoral - periapical first radiographic image |
6,071 |
5,891 |
$68K |
| D0330 |
Panoramic radiographic image |
2,112 |
2,108 |
$64K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,927 |
4,732 |
$45K |
| D4341 |
|
373 |
123 |
$44K |
| D1120 |
Prophylaxis - child |
917 |
914 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
193 |
87 |
$13K |
| D4346 |
|
70 |
70 |
$8K |
| D9110 |
|
86 |
84 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
105 |
83 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
121 |
121 |
$3K |