| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
3,969 |
1,881 |
$493K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,529 |
2,353 |
$469K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,660 |
1,237 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
4,310 |
4,183 |
$107K |
| D1110 |
Prophylaxis - adult |
2,907 |
2,808 |
$106K |
| D2394 |
|
551 |
332 |
$80K |
| D0140 |
Limited oral evaluation - problem focused |
1,650 |
1,566 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
3,696 |
3,478 |
$54K |
| D1206 |
Topical application of fluoride varnish |
3,394 |
3,278 |
$53K |
| D0274 |
Bitewings - four radiographic images |
1,737 |
1,686 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
745 |
723 |
$50K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,113 |
1,078 |
$45K |
| D1120 |
Prophylaxis - child |
1,502 |
1,455 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,812 |
2,150 |
$33K |
| D0330 |
Panoramic radiographic image |
628 |
611 |
$29K |
| D2332 |
|
181 |
102 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
124 |
56 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
180 |
88 |
$11K |
| D0272 |
Bitewings - two radiographic images |
446 |
436 |
$7K |
| D2335 |
|
15 |
12 |
$2K |
| D4355 |
|
13 |
12 |
$629.96 |