| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,522 |
1,157 |
$309K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,217 |
1,132 |
$224K |
| D0140 |
Limited oral evaluation - problem focused |
2,903 |
2,619 |
$99K |
| D0120 |
Periodic oral evaluation - established patient |
4,240 |
3,852 |
$99K |
| D4355 |
|
1,510 |
1,394 |
$93K |
| D0330 |
Panoramic radiographic image |
2,276 |
2,046 |
$90K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
900 |
370 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
6,785 |
5,692 |
$85K |
| D0274 |
Bitewings - four radiographic images |
3,031 |
2,713 |
$80K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,916 |
3,776 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,331 |
1,221 |
$41K |
| D1110 |
Prophylaxis - adult |
1,174 |
1,084 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
491 |
274 |
$36K |
| D4346 |
|
833 |
711 |
$27K |
| D2394 |
|
176 |
89 |
$25K |
| D2332 |
|
258 |
65 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
256 |
135 |
$16K |
| D7311 |
|
163 |
124 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
680 |
662 |
$11K |
| D4341 |
|
93 |
43 |
$9K |
| D2335 |
|
57 |
30 |
$7K |
| D1206 |
Topical application of fluoride varnish |
411 |
358 |
$6K |
| D2950 |
|
56 |
40 |
$6K |
| D7450 |
|
31 |
28 |
$5K |
| D1120 |
Prophylaxis - child |
155 |
150 |
$4K |
| D1351 |
Sealant - per tooth |
50 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
67 |
63 |
$1K |