| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,507 |
808 |
$61K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,322 |
789 |
$49K |
| D1110 |
Prophylaxis - adult |
2,855 |
2,854 |
$48K |
| D0120 |
Periodic oral evaluation - established patient |
2,504 |
2,502 |
$35K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,467 |
1,467 |
$28K |
| D7140 |
Extraction, erupted tooth or exposed root |
845 |
448 |
$25K |
| D2332 |
|
645 |
289 |
$24K |
| D2335 |
|
316 |
113 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,662 |
3,607 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
548 |
353 |
$16K |
| D1120 |
Prophylaxis - child |
1,029 |
1,028 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
4,096 |
3,990 |
$14K |
| D0274 |
Bitewings - four radiographic images |
1,869 |
1,868 |
$13K |
| D1206 |
Topical application of fluoride varnish |
1,154 |
1,153 |
$12K |
| D2952 |
|
163 |
127 |
$11K |
| D2750 |
|
32 |
27 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
364 |
364 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
531 |
521 |
$8K |
| D0272 |
Bitewings - two radiographic images |
1,050 |
1,049 |
$5K |
| D9920 |
|
302 |
301 |
$3K |
| D0603 |
|
420 |
420 |
$3K |
| D0330 |
Panoramic radiographic image |
80 |
80 |
$2K |
| D9210 |
|
207 |
182 |
$2K |
| D4341 |
|
29 |
12 |
$1K |
| D0270 |
|
17 |
17 |
$47.00 |