| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,552 |
1,374 |
$219K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,362 |
1,549 |
$215K |
| D0330 |
Panoramic radiographic image |
2,608 |
2,536 |
$135K |
| D1110 |
Prophylaxis - adult |
3,343 |
3,245 |
$135K |
| D0210 |
Intraoral - complete series of radiographic images |
2,000 |
1,861 |
$114K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,543 |
932 |
$113K |
| D0140 |
Limited oral evaluation - problem focused |
4,648 |
4,378 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,223 |
3,116 |
$97K |
| D0120 |
Periodic oral evaluation - established patient |
3,412 |
3,320 |
$69K |
| D0274 |
Bitewings - four radiographic images |
2,478 |
2,416 |
$56K |
| D9243 |
|
936 |
248 |
$50K |
| D9223 |
Deep sedation/general anesthesia - each subsequent 15 minute increment |
630 |
140 |
$39K |
| D9239 |
|
475 |
432 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,261 |
2,106 |
$34K |
| D2335 |
|
306 |
146 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,504 |
1,454 |
$28K |
| D1120 |
Prophylaxis - child |
1,192 |
1,148 |
$27K |
| D2332 |
|
278 |
156 |
$25K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
391 |
66 |
$24K |
| D9222 |
|
169 |
155 |
$21K |
| D2394 |
|
271 |
174 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
3,336 |
3,177 |
$19K |
| D9612 |
|
282 |
268 |
$15K |
| D2331 |
|
204 |
119 |
$13K |
| D9610 |
|
160 |
139 |
$9K |
| D0250 |
|
683 |
639 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
121 |
53 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
451 |
442 |
$7K |
| D7240 |
Removal of impacted tooth - completely bony |
26 |
12 |
$5K |
| D2330 |
|
96 |
54 |
$5K |
| D0272 |
Bitewings - two radiographic images |
256 |
253 |
$3K |
| D0270 |
|
164 |
162 |
$787.50 |