| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,221 |
1,032 |
$267K |
| D1110 |
Prophylaxis - adult |
2,068 |
1,950 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
2,876 |
2,730 |
$68K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,936 |
1,754 |
$62K |
| D0274 |
Bitewings - four radiographic images |
1,899 |
1,770 |
$55K |
| D0330 |
Panoramic radiographic image |
950 |
854 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
2,869 |
2,374 |
$40K |
| D4355 |
|
502 |
497 |
$34K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
254 |
121 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
485 |
452 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
963 |
914 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
170 |
92 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
218 |
186 |
$8K |