| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
7,297 |
2,035 |
$856K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,569 |
1,504 |
$345K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,806 |
943 |
$202K |
| D2394 |
|
816 |
396 |
$112K |
| D1110 |
Prophylaxis - adult |
2,721 |
2,475 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,159 |
1,951 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
3,178 |
2,926 |
$77K |
| D0330 |
Panoramic radiographic image |
1,882 |
1,684 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,255 |
2,957 |
$58K |
| D0274 |
Bitewings - four radiographic images |
2,162 |
1,936 |
$58K |
| D0220 |
Intraoral - periapical first radiographic image |
3,978 |
3,544 |
$55K |
| D1120 |
Prophylaxis - child |
1,924 |
1,787 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,165 |
1,030 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,282 |
2,145 |
$37K |
| D0272 |
Bitewings - two radiographic images |
1,007 |
925 |
$17K |
| D2335 |
|
70 |
39 |
$8K |
| D1206 |
Topical application of fluoride varnish |
545 |
487 |
$8K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
50 |
15 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
55 |
25 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
12 |
$746.80 |