| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,280 |
1,840 |
$618K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,653 |
1,350 |
$556K |
| D2335 |
|
1,360 |
581 |
$203K |
| D7240 |
Removal of impacted tooth - completely bony |
646 |
285 |
$192K |
| D7140 |
Extraction, erupted tooth or exposed root |
901 |
252 |
$108K |
| D2330 |
|
1,205 |
567 |
$100K |
| D1110 |
Prophylaxis - adult |
1,415 |
1,392 |
$81K |
| D3310 |
|
125 |
62 |
$65K |
| D2332 |
|
523 |
299 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
586 |
283 |
$51K |
| D3320 |
|
73 |
57 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,364 |
1,345 |
$40K |
| D2950 |
|
533 |
299 |
$30K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
42 |
25 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
429 |
422 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
946 |
941 |
$22K |
| D2394 |
|
123 |
75 |
$21K |
| D9940 |
|
43 |
43 |
$9K |
| D1120 |
Prophylaxis - child |
182 |
180 |
$8K |
| D0272 |
Bitewings - two radiographic images |
330 |
328 |
$6K |
| D0330 |
Panoramic radiographic image |
133 |
130 |
$6K |
| D8670 |
Periodic orthodontic treatment visit |
70 |
68 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
409 |
399 |
$4K |
| D2331 |
|
20 |
16 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
242 |
234 |
$1K |
| D1330 |
|
55 |
55 |
$324.00 |