| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,211 |
1,500 |
$539K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,800 |
1,352 |
$295K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,968 |
988 |
$236K |
| D2394 |
|
1,078 |
508 |
$159K |
| D0330 |
Panoramic radiographic image |
1,459 |
1,426 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,539 |
2,512 |
$64K |
| D1110 |
Prophylaxis - adult |
1,682 |
1,655 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,918 |
1,884 |
$58K |
| D2332 |
|
495 |
241 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,090 |
2,985 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
424 |
195 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,073 |
1,043 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,747 |
2,546 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,098 |
1,044 |
$38K |
| D7140 |
Extraction, erupted tooth or exposed root |
567 |
248 |
$37K |
| D2335 |
|
302 |
131 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
946 |
933 |
$16K |
| D1120 |
Prophylaxis - child |
585 |
577 |
$16K |
| D4355 |
|
237 |
231 |
$15K |
| D4341 |
|
109 |
54 |
$10K |
| D7311 |
|
65 |
46 |
$6K |
| D0272 |
Bitewings - two radiographic images |
303 |
298 |
$5K |
| D2331 |
|
18 |
12 |
$2K |
| D1206 |
Topical application of fluoride varnish |
77 |
77 |
$1K |