| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,893 |
2,246 |
$474K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,752 |
2,699 |
$473K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
4,322 |
1,408 |
$443K |
| D2394 |
|
2,207 |
1,300 |
$320K |
| D1110 |
Prophylaxis - adult |
6,382 |
5,930 |
$230K |
| D0210 |
Intraoral - complete series of radiographic images |
2,781 |
2,533 |
$184K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,482 |
1,463 |
$178K |
| D2335 |
|
1,476 |
747 |
$172K |
| D0140 |
Limited oral evaluation - problem focused |
4,824 |
4,396 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
6,682 |
6,306 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,865 |
2,604 |
$115K |
| D4355 |
|
1,677 |
1,525 |
$104K |
| D0330 |
Panoramic radiographic image |
1,874 |
1,737 |
$101K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,603 |
5,274 |
$90K |
| D1120 |
Prophylaxis - child |
3,154 |
2,969 |
$81K |
| D2332 |
|
761 |
447 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,006 |
1,862 |
$60K |
| D0220 |
Intraoral - periapical first radiographic image |
4,033 |
3,605 |
$58K |
| D2331 |
|
680 |
451 |
$51K |
| D7140 |
Extraction, erupted tooth or exposed root |
743 |
361 |
$43K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,185 |
1,354 |
$37K |
| D3310 |
|
128 |
71 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,561 |
1,450 |
$27K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
537 |
406 |
$22K |
| D2330 |
|
351 |
219 |
$21K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
37 |
34 |
$16K |
| D5110 |
|
12 |
12 |
$7K |
| D0170 |
|
268 |
217 |
$6K |
| D9110 |
|
73 |
54 |
$3K |
| D2161 |
|
17 |
14 |
$2K |
| D3351 |
|
16 |
13 |
$2K |