| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
10,704 |
3,645 |
$1.00M |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12,012 |
3,333 |
$784K |
| D0140 |
Limited oral evaluation - problem focused |
18,036 |
14,773 |
$460K |
| D2332 |
|
4,688 |
1,872 |
$431K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
5,174 |
1,564 |
$423K |
| D9110 |
|
4,543 |
3,944 |
$277K |
| D9610 |
|
4,836 |
4,272 |
$265K |
| D2335 |
|
1,695 |
711 |
$231K |
| D1110 |
Prophylaxis - adult |
5,215 |
4,910 |
$220K |
| D0330 |
Panoramic radiographic image |
4,181 |
3,779 |
$131K |
| D1206 |
Topical application of fluoride varnish |
7,243 |
6,830 |
$123K |
| D0220 |
Intraoral - periapical first radiographic image |
10,434 |
9,191 |
$91K |
| D0274 |
Bitewings - four radiographic images |
6,711 |
6,200 |
$81K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,779 |
1,558 |
$46K |
| D1120 |
Prophylaxis - child |
1,514 |
1,432 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,999 |
7,001 |
$30K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
492 |
252 |
$27K |
| D4341 |
|
576 |
187 |
$24K |
| D1999 |
|
1,606 |
1,225 |
$13K |
| D2330 |
|
177 |
94 |
$10K |
| D3221 |
|
135 |
104 |
$7K |
| D4910 |
|
117 |
110 |
$5K |
| D9930 |
|
50 |
39 |
$2K |
| D2331 |
|
61 |
26 |
$2K |
| D0272 |
Bitewings - two radiographic images |
85 |
79 |
$810.53 |
| D1208 |
Topical application of fluoride, excluding varnish |
53 |
52 |
$690.68 |