| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,980 |
1,060 |
$331K |
| D1110 |
Prophylaxis - adult |
3,955 |
3,850 |
$249K |
| D4341 |
|
2,472 |
644 |
$211K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,850 |
3,769 |
$205K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,375 |
533 |
$169K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,337 |
664 |
$167K |
| D1120 |
Prophylaxis - child |
3,560 |
3,483 |
$156K |
| D1351 |
Sealant - per tooth |
4,359 |
669 |
$155K |
| D1206 |
Topical application of fluoride varnish |
5,592 |
5,464 |
$140K |
| D0330 |
Panoramic radiographic image |
2,946 |
2,847 |
$128K |
| D0120 |
Periodic oral evaluation - established patient |
3,809 |
3,709 |
$115K |
| D2750 |
|
222 |
177 |
$109K |
| D0274 |
Bitewings - four radiographic images |
2,990 |
2,902 |
$69K |
| D0140 |
Limited oral evaluation - problem focused |
964 |
885 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,815 |
1,765 |
$41K |
| D3320 |
|
39 |
36 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
265 |
133 |
$23K |
| D2332 |
|
171 |
97 |
$23K |
| D2335 |
|
116 |
84 |
$20K |
| D2950 |
|
211 |
164 |
$18K |
| D1330 |
|
2,786 |
2,722 |
$17K |
| D0220 |
Intraoral - periapical first radiographic image |
964 |
884 |
$11K |
| D3120 |
|
287 |
198 |
$10K |
| D0272 |
Bitewings - two radiographic images |
454 |
452 |
$7K |
| D7220 |
|
35 |
27 |
$6K |
| D2394 |
|
27 |
23 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25 |
24 |
$223.04 |