| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,565 |
1,353 |
$339K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
2,226 |
628 |
$220K |
| D3310 |
|
428 |
239 |
$198K |
| D2332 |
|
1,497 |
773 |
$164K |
| D7970 |
|
1,508 |
1,465 |
$162K |
| D2950 |
|
1,486 |
874 |
$100K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,224 |
2,354 |
$99K |
| D0274 |
Bitewings - four radiographic images |
2,319 |
2,280 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
1,235 |
1,171 |
$67K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,895 |
2,843 |
$60K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,134 |
2,512 |
$58K |
| D2394 |
|
395 |
196 |
$56K |
| D1110 |
Prophylaxis - adult |
1,503 |
1,459 |
$54K |
| D3320 |
|
90 |
73 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,900 |
1,874 |
$47K |
| D1120 |
Prophylaxis - child |
1,045 |
1,035 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,581 |
1,500 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,432 |
3,300 |
$42K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
45 |
26 |
$24K |
| D2335 |
|
150 |
93 |
$20K |
| D1351 |
Sealant - per tooth |
254 |
57 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
126 |
70 |
$8K |
| D3110 |
|
24 |
12 |
$2K |