| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,887 |
1,890 |
$248K |
| D1110 |
Prophylaxis - adult |
5,710 |
5,580 |
$247K |
| D2791 |
|
393 |
254 |
$206K |
| D1208 |
Topical application of fluoride, excluding varnish |
7,969 |
7,781 |
$167K |
| D0120 |
Periodic oral evaluation - established patient |
6,444 |
6,284 |
$156K |
| D2394 |
|
1,688 |
1,190 |
$153K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
4,676 |
4,191 |
$135K |
| D0330 |
Panoramic radiographic image |
2,654 |
2,590 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,865 |
1,080 |
$115K |
| D2950 |
|
890 |
523 |
$109K |
| D0274 |
Bitewings - four radiographic images |
4,502 |
4,404 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,237 |
889 |
$92K |
| D2335 |
|
1,031 |
455 |
$88K |
| D1120 |
Prophylaxis - child |
2,502 |
2,441 |
$83K |
| D0220 |
Intraoral - periapical first radiographic image |
5,771 |
5,497 |
$67K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,534 |
4,971 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,640 |
1,602 |
$47K |
| D1351 |
Sealant - per tooth |
1,448 |
411 |
$46K |
| D2332 |
|
143 |
78 |
$12K |
| D1353 |
|
363 |
118 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$10K |
| D9110 |
|
72 |
65 |
$3K |
| D9944 |
|
24 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
121 |
120 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
12 |
$1K |