| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,693 |
1,606 |
$217K |
| D1110 |
Prophylaxis - adult |
4,508 |
4,297 |
$198K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,958 |
1,676 |
$189K |
| D2335 |
|
1,118 |
502 |
$149K |
| D2394 |
|
1,587 |
1,002 |
$148K |
| D2332 |
|
1,117 |
667 |
$110K |
| D0274 |
Bitewings - four radiographic images |
3,242 |
3,070 |
$91K |
| D0120 |
Periodic oral evaluation - established patient |
4,182 |
3,999 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,452 |
2,332 |
$83K |
| D0210 |
Intraoral - complete series of radiographic images |
3,234 |
1,969 |
$82K |
| D0140 |
Limited oral evaluation - problem focused |
2,235 |
2,100 |
$72K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,706 |
2,311 |
$58K |
| D0330 |
Panoramic radiographic image |
1,265 |
1,192 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
4,691 |
4,305 |
$45K |
| D1206 |
Topical application of fluoride varnish |
1,434 |
1,377 |
$30K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
194 |
104 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
389 |
251 |
$20K |
| D4346 |
|
71 |
69 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
814 |
775 |
$8K |
| D1120 |
Prophylaxis - child |
52 |
52 |
$103.50 |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$49.62 |
| D0431 |
|
14 |
14 |
$0.00 |