| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,782 |
1,069 |
$209K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,593 |
897 |
$134K |
| D4341 |
|
662 |
349 |
$106K |
| D1110 |
Prophylaxis - adult |
1,468 |
1,441 |
$59K |
| D9110 |
|
978 |
907 |
$53K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
625 |
384 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,893 |
1,825 |
$44K |
| D1120 |
Prophylaxis - child |
954 |
944 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,101 |
1,099 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
1,098 |
1,035 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,111 |
1,092 |
$26K |
| D0330 |
Panoramic radiographic image |
945 |
928 |
$23K |
| D2332 |
|
180 |
110 |
$22K |
| D1351 |
Sealant - per tooth |
738 |
133 |
$20K |
| D0274 |
Bitewings - four radiographic images |
1,184 |
1,157 |
$19K |
| D2394 |
|
187 |
108 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
270 |
172 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,003 |
980 |
$7K |
| D7510 |
|
151 |
131 |
$6K |
| D2335 |
|
36 |
24 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
494 |
437 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
197 |
193 |
$4K |
| D4910 |
|
14 |
14 |
$938.00 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$130.84 |