| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,825 |
2,543 |
$496K |
| D2335 |
|
3,434 |
1,873 |
$425K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,641 |
2,545 |
$394K |
| D2394 |
|
2,076 |
1,475 |
$322K |
| D0330 |
Panoramic radiographic image |
4,402 |
4,364 |
$258K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,104 |
1,537 |
$250K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,162 |
1,178 |
$237K |
| D1110 |
Prophylaxis - adult |
6,068 |
6,024 |
$236K |
| D0120 |
Periodic oral evaluation - established patient |
8,567 |
8,486 |
$219K |
| D0274 |
Bitewings - four radiographic images |
5,432 |
5,388 |
$173K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,548 |
1,249 |
$164K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,351 |
3,313 |
$147K |
| D0140 |
Limited oral evaluation - problem focused |
3,611 |
3,554 |
$135K |
| D2332 |
|
1,371 |
841 |
$133K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,263 |
6,226 |
$107K |
| D0220 |
Intraoral - periapical first radiographic image |
6,387 |
6,187 |
$92K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,643 |
3,493 |
$92K |
| D1120 |
Prophylaxis - child |
3,164 |
3,140 |
$88K |
| D4355 |
|
1,249 |
1,230 |
$85K |
| D0272 |
Bitewings - two radiographic images |
2,327 |
2,308 |
$44K |
| D7311 |
|
256 |
181 |
$23K |
| D9410 |
|
255 |
248 |
$19K |
| D7250 |
|
147 |
54 |
$18K |
| D7530 |
|
134 |
79 |
$11K |
| D7111 |
|
87 |
61 |
$4K |
| D7510 |
|
13 |
12 |
$2K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
17 |
13 |
$1K |
| D9110 |
|
13 |
12 |
$578.76 |
| D2940 |
|
14 |
13 |
$567.58 |