| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
10,645 |
3,251 |
$1.36M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,917 |
2,101 |
$450K |
| D2332 |
|
4,531 |
1,183 |
$425K |
| D2394 |
|
2,549 |
1,293 |
$391K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,848 |
988 |
$201K |
| D0120 |
Periodic oral evaluation - established patient |
7,011 |
6,863 |
$176K |
| D1110 |
Prophylaxis - adult |
4,530 |
4,436 |
$167K |
| D4355 |
|
2,208 |
2,127 |
$142K |
| D0274 |
Bitewings - four radiographic images |
4,017 |
3,891 |
$121K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
986 |
452 |
$105K |
| D2335 |
|
853 |
312 |
$103K |
| D0330 |
Panoramic radiographic image |
1,930 |
1,858 |
$99K |
| D1206 |
Topical application of fluoride varnish |
4,259 |
4,160 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,512 |
1,448 |
$64K |
| D2331 |
|
691 |
202 |
$52K |
| D7311 |
|
364 |
243 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,344 |
2,156 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
920 |
887 |
$32K |
| D1120 |
Prophylaxis - child |
1,171 |
1,150 |
$32K |
| D4341 |
|
272 |
121 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,927 |
785 |
$20K |
| D4346 |
|
154 |
154 |
$5K |
| D9110 |
|
121 |
110 |
$4K |
| D1351 |
Sealant - per tooth |
120 |
26 |
$3K |
| D0272 |
Bitewings - two radiographic images |
79 |
79 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
12 |
12 |
$188.64 |
| D1999 |
|
127 |
119 |
$0.00 |