| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,169 |
446 |
$123K |
| D1110 |
Prophylaxis - adult |
1,851 |
1,674 |
$96K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,257 |
2,026 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,871 |
3,568 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,109 |
1,989 |
$57K |
| D0330 |
Panoramic radiographic image |
1,439 |
1,319 |
$55K |
| D0274 |
Bitewings - four radiographic images |
2,787 |
2,596 |
$39K |
| D1120 |
Prophylaxis - child |
1,685 |
1,591 |
$36K |
| D2335 |
|
184 |
39 |
$24K |
| D0220 |
Intraoral - periapical first radiographic image |
2,054 |
1,898 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
163 |
38 |
$19K |
| D2332 |
|
158 |
54 |
$15K |
| D4341 |
|
372 |
113 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
159 |
118 |
$6K |
| D1999 |
|
391 |
328 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
161 |
148 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,761 |
1,418 |
$4K |
| D0240 |
|
26 |
13 |
$213.84 |