| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,642 |
959 |
$311K |
| D2394 |
|
2,039 |
673 |
$295K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,426 |
892 |
$232K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,848 |
577 |
$135K |
| D0140 |
Limited oral evaluation - problem focused |
1,261 |
1,078 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
937 |
839 |
$38K |
| D1110 |
Prophylaxis - adult |
1,090 |
976 |
$37K |
| D0330 |
Panoramic radiographic image |
697 |
606 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,360 |
1,791 |
$32K |
| D0274 |
Bitewings - four radiographic images |
1,123 |
968 |
$31K |
| D4355 |
|
512 |
427 |
$29K |
| D0120 |
Periodic oral evaluation - established patient |
1,084 |
971 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,047 |
1,395 |
$22K |
| D1120 |
Prophylaxis - child |
572 |
521 |
$14K |
| D2335 |
|
118 |
51 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
167 |
27 |
$11K |
| D1206 |
Topical application of fluoride varnish |
739 |
656 |
$11K |
| D0170 |
|
421 |
344 |
$11K |
| D2332 |
|
43 |
13 |
$4K |
| D0272 |
Bitewings - two radiographic images |
52 |
50 |
$928.80 |
| D1208 |
Topical application of fluoride, excluding varnish |
41 |
40 |
$686.49 |
| D9995 |
|
46 |
35 |
$0.00 |