| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
7,340 |
3,005 |
$1.12M |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,404 |
2,544 |
$695K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,786 |
1,620 |
$295K |
| D1110 |
Prophylaxis - adult |
6,877 |
6,737 |
$254K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,330 |
869 |
$249K |
| D0274 |
Bitewings - four radiographic images |
7,710 |
7,403 |
$219K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,934 |
4,688 |
$206K |
| D0330 |
Panoramic radiographic image |
4,737 |
4,471 |
$205K |
| D0120 |
Periodic oral evaluation - established patient |
7,494 |
7,327 |
$187K |
| D0220 |
Intraoral - periapical first radiographic image |
11,865 |
11,239 |
$171K |
| D0140 |
Limited oral evaluation - problem focused |
4,705 |
4,242 |
$165K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,415 |
9,491 |
$158K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,282 |
774 |
$104K |
| D2332 |
|
475 |
276 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,403 |
2,357 |
$40K |
| D2335 |
|
260 |
164 |
$32K |
| D4355 |
|
107 |
107 |
$7K |
| D1120 |
Prophylaxis - child |
128 |
128 |
$4K |
| D4341 |
|
25 |
13 |
$3K |
| D2331 |
|
20 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
88 |
88 |
$2K |
| D1206 |
Topical application of fluoride varnish |
37 |
35 |
$306.19 |
| D1999 |
|
63 |
61 |
$0.00 |