| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,688 |
822 |
$90K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,058 |
976 |
$90K |
| D1110 |
Prophylaxis - adult |
2,439 |
2,189 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
2,921 |
2,350 |
$49K |
| D4341 |
|
2,230 |
650 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,964 |
1,845 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,550 |
1,334 |
$36K |
| D2332 |
|
608 |
283 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,447 |
2,180 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
689 |
327 |
$23K |
| D1120 |
Prophylaxis - child |
1,117 |
1,052 |
$21K |
| D0274 |
Bitewings - four radiographic images |
2,380 |
2,142 |
$19K |
| D7220 |
|
231 |
116 |
$16K |
| D1999 |
|
1,264 |
924 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
2,104 |
1,712 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
392 |
369 |
$10K |
| D1351 |
Sealant - per tooth |
443 |
76 |
$6K |
| D0330 |
Panoramic radiographic image |
307 |
276 |
$6K |
| D2394 |
|
87 |
56 |
$5K |
| D0272 |
Bitewings - two radiographic images |
353 |
318 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$897.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
694 |
357 |
$895.34 |
| D2331 |
|
14 |
12 |
$677.01 |