| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,548 |
762 |
$437K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,948 |
1,232 |
$406K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,657 |
1,067 |
$356K |
| D2750 |
|
406 |
270 |
$191K |
| D7240 |
Removal of impacted tooth - completely bony |
453 |
231 |
$134K |
| D4341 |
|
1,533 |
420 |
$132K |
| D2332 |
|
796 |
218 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,654 |
1,624 |
$91K |
| D0330 |
Panoramic radiographic image |
1,542 |
1,519 |
$70K |
| D2394 |
|
312 |
135 |
$54K |
| D1110 |
Prophylaxis - adult |
760 |
757 |
$50K |
| D3120 |
|
1,313 |
153 |
$46K |
| D1120 |
Prophylaxis - child |
993 |
979 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,436 |
1,415 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
894 |
850 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,524 |
1,497 |
$36K |
| D2330 |
|
370 |
184 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,482 |
1,457 |
$34K |
| D2331 |
|
292 |
148 |
$34K |
| D2950 |
|
317 |
212 |
$27K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
28 |
25 |
$21K |
| D3320 |
|
33 |
24 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
124 |
67 |
$14K |
| D1206 |
Topical application of fluoride varnish |
431 |
427 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
840 |
812 |
$9K |
| D1330 |
|
604 |
596 |
$4K |
| D4355 |
|
12 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$180.00 |