| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,326 |
1,552 |
$278K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,547 |
1,672 |
$257K |
| D2394 |
|
1,473 |
919 |
$207K |
| D2335 |
|
1,555 |
809 |
$179K |
| D0140 |
Limited oral evaluation - problem focused |
3,590 |
3,263 |
$121K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,053 |
439 |
$108K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,447 |
924 |
$102K |
| D2332 |
|
956 |
615 |
$88K |
| D1110 |
Prophylaxis - adult |
2,352 |
2,205 |
$85K |
| D0120 |
Periodic oral evaluation - established patient |
3,121 |
2,924 |
$75K |
| D0330 |
Panoramic radiographic image |
1,124 |
1,039 |
$55K |
| D4355 |
|
877 |
805 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,261 |
1,180 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,377 |
2,073 |
$49K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,066 |
2,856 |
$48K |
| D0220 |
Intraoral - periapical first radiographic image |
3,434 |
3,142 |
$48K |
| D0274 |
Bitewings - four radiographic images |
1,460 |
1,360 |
$43K |
| D1120 |
Prophylaxis - child |
1,548 |
1,450 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
770 |
697 |
$34K |
| D3310 |
|
112 |
71 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
421 |
397 |
$27K |
| D0272 |
Bitewings - two radiographic images |
713 |
667 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
145 |
101 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
18 |
14 |
$6K |
| D7311 |
|
18 |
14 |
$2K |
| D1206 |
Topical application of fluoride varnish |
41 |
40 |
$604.08 |
| D0240 |
|
29 |
15 |
$484.59 |