| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,345 |
834 |
$255K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,948 |
855 |
$204K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,921 |
455 |
$125K |
| D2394 |
|
1,250 |
313 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,234 |
1,533 |
$67K |
| D1110 |
Prophylaxis - adult |
2,004 |
1,422 |
$54K |
| D0274 |
Bitewings - four radiographic images |
2,219 |
1,556 |
$48K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,173 |
2,021 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,965 |
1,524 |
$39K |
| D0330 |
Panoramic radiographic image |
1,188 |
767 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
3,271 |
2,326 |
$35K |
| D2335 |
|
688 |
110 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,741 |
1,306 |
$22K |
| D1120 |
Prophylaxis - child |
1,013 |
797 |
$22K |
| D2332 |
|
447 |
113 |
$17K |
| D4355 |
|
287 |
260 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
440 |
339 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
108 |
40 |
$9K |
| D0272 |
Bitewings - two radiographic images |
279 |
189 |
$3K |
| D2331 |
|
165 |
27 |
$3K |