| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,812 |
1,062 |
$236K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,181 |
1,331 |
$233K |
| D2394 |
|
780 |
512 |
$123K |
| D0330 |
Panoramic radiographic image |
2,104 |
2,034 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
4,678 |
4,606 |
$117K |
| D1110 |
Prophylaxis - adult |
2,537 |
2,491 |
$97K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,340 |
314 |
$87K |
| D0274 |
Bitewings - four radiographic images |
2,583 |
2,508 |
$83K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,735 |
4,315 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,711 |
1,643 |
$74K |
| D0220 |
Intraoral - periapical first radiographic image |
4,857 |
4,720 |
$73K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,311 |
3,257 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
677 |
443 |
$56K |
| D1120 |
Prophylaxis - child |
1,981 |
1,949 |
$55K |
| D4355 |
|
696 |
668 |
$46K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
329 |
113 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
932 |
900 |
$33K |
| D2332 |
|
249 |
162 |
$23K |
| D9239 |
|
312 |
308 |
$23K |
| D0272 |
Bitewings - two radiographic images |
966 |
950 |
$18K |
| D9612 |
|
282 |
279 |
$17K |
| D2335 |
|
121 |
63 |
$15K |
| D7250 |
|
107 |
26 |
$13K |
| D7240 |
Removal of impacted tooth - completely bony |
30 |
14 |
$6K |
| D1351 |
Sealant - per tooth |
77 |
12 |
$2K |
| D9610 |
|
28 |
27 |
$990.90 |
| D9243 |
|
12 |
12 |
$904.32 |