| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
8,376 |
1,733 |
$1.10M |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,376 |
634 |
$653K |
| D1110 |
Prophylaxis - adult |
3,823 |
3,727 |
$174K |
| D0330 |
Panoramic radiographic image |
2,915 |
2,884 |
$140K |
| D0120 |
Periodic oral evaluation - established patient |
6,425 |
6,302 |
$135K |
| D1120 |
Prophylaxis - child |
3,851 |
3,797 |
$115K |
| D0274 |
Bitewings - four radiographic images |
3,765 |
3,692 |
$114K |
| D2335 |
|
845 |
246 |
$104K |
| D1208 |
Topical application of fluoride, excluding varnish |
6,300 |
6,214 |
$94K |
| D3120 |
|
2,936 |
491 |
$86K |
| D3240 |
|
588 |
116 |
$62K |
| D2934 |
|
537 |
103 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
3,388 |
3,245 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,684 |
1,646 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
533 |
214 |
$50K |
| D2394 |
|
260 |
122 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,359 |
1,330 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,187 |
1,095 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,417 |
1,799 |
$26K |
| D7140 |
Extraction, erupted tooth or exposed root |
292 |
119 |
$19K |
| D2390 |
|
69 |
15 |
$14K |
| D4341 |
|
43 |
12 |
$6K |