| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
5,111 |
1,211 |
$527K |
| D2332 |
|
660 |
221 |
$74K |
| D0274 |
Bitewings - four radiographic images |
2,274 |
2,209 |
$72K |
| D1110 |
Prophylaxis - adult |
1,790 |
1,706 |
$62K |
| D1120 |
Prophylaxis - child |
1,401 |
1,371 |
$61K |
| D0140 |
Limited oral evaluation - problem focused |
2,087 |
1,919 |
$60K |
| D0120 |
Periodic oral evaluation - established patient |
2,259 |
2,167 |
$57K |
| D2394 |
|
382 |
215 |
$54K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,677 |
1,442 |
$41K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,587 |
1,566 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
474 |
131 |
$30K |
| D1206 |
Topical application of fluoride varnish |
1,378 |
1,352 |
$23K |
| D7450 |
|
246 |
180 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,316 |
1,264 |
$17K |
| D0330 |
Panoramic radiographic image |
324 |
298 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
321 |
306 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
164 |
106 |
$11K |
| D7970 |
|
103 |
89 |
$11K |
| D1351 |
Sealant - per tooth |
263 |
59 |
$10K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
14 |
12 |
$6K |
| D2335 |
|
26 |
13 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
23 |
22 |
$1K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$710.40 |