| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,880 |
1,491 |
$316K |
| D2394 |
|
2,358 |
1,290 |
$221K |
| D1110 |
Prophylaxis - adult |
3,221 |
3,218 |
$147K |
| D0210 |
Intraoral - complete series of radiographic images |
1,884 |
1,884 |
$89K |
| D4910 |
|
1,249 |
1,244 |
$83K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,502 |
4,447 |
$81K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,182 |
2,181 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,075 |
488 |
$75K |
| D2332 |
|
772 |
378 |
$75K |
| D9630 |
|
3,674 |
3,530 |
$62K |
| D0140 |
Limited oral evaluation - problem focused |
1,681 |
1,598 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
4,489 |
3,807 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
1,593 |
1,591 |
$42K |
| D0180 |
|
1,028 |
1,027 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,940 |
3,208 |
$38K |
| D4341 |
|
502 |
220 |
$33K |
| D1120 |
Prophylaxis - child |
790 |
788 |
$31K |
| D4342 |
|
572 |
250 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,042 |
1,041 |
$29K |
| D0603 |
|
2,516 |
2,512 |
$27K |
| D1330 |
|
2,608 |
2,602 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
362 |
173 |
$20K |
| D1206 |
Topical application of fluoride varnish |
885 |
850 |
$15K |
| D9920 |
|
360 |
306 |
$14K |
| D9110 |
|
288 |
277 |
$13K |
| D0191 |
|
699 |
699 |
$12K |
| D2335 |
|
79 |
49 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
78 |
56 |
$8K |
| D1999 |
|
1,225 |
928 |
$4K |
| D0240 |
|
27 |
13 |
$432.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
14 |
12 |
$364.00 |
| D1320 |
|
21 |
18 |
$210.00 |