| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,527 |
1,361 |
$259K |
| D9610 |
|
3,924 |
3,464 |
$239K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,708 |
1,422 |
$214K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,188 |
2,160 |
$96K |
| D1110 |
Prophylaxis - adult |
1,704 |
1,687 |
$88K |
| D0330 |
Panoramic radiographic image |
2,476 |
2,442 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,010 |
339 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,715 |
1,679 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,439 |
3,272 |
$38K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
324 |
165 |
$37K |
| D0274 |
Bitewings - four radiographic images |
2,470 |
2,438 |
$37K |
| D2394 |
|
319 |
250 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,023 |
1,013 |
$34K |
| D4341 |
|
671 |
209 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
434 |
282 |
$26K |
| D1206 |
Topical application of fluoride varnish |
1,033 |
1,024 |
$23K |
| D2332 |
|
140 |
89 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,277 |
2,300 |
$14K |
| D2335 |
|
74 |
42 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
118 |
117 |
$6K |
| D0270 |
|
280 |
274 |
$2K |
| D1120 |
Prophylaxis - child |
95 |
93 |
$2K |
| D2330 |
|
14 |
13 |
$693.03 |