| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
11,311 |
3,913 |
$1.11M |
| D2394 |
|
8,845 |
2,701 |
$945K |
| D2335 |
|
6,078 |
1,871 |
$771K |
| D2332 |
|
7,305 |
2,550 |
$766K |
| D4341 |
|
9,381 |
2,208 |
$379K |
| D9110 |
|
6,546 |
4,370 |
$322K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
3,040 |
711 |
$316K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,688 |
3,400 |
$147K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,804 |
1,072 |
$132K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,332 |
4,978 |
$110K |
| D0210 |
Intraoral - complete series of radiographic images |
1,923 |
1,767 |
$103K |
| D1110 |
Prophylaxis - adult |
1,698 |
1,588 |
$76K |
| D0120 |
Periodic oral evaluation - established patient |
1,662 |
1,586 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
5,671 |
3,691 |
$43K |
| D2331 |
|
450 |
276 |
$37K |
| D0274 |
Bitewings - four radiographic images |
2,677 |
2,489 |
$36K |
| D1351 |
Sealant - per tooth |
1,426 |
249 |
$32K |
| D4910 |
|
263 |
247 |
$21K |
| D1120 |
Prophylaxis - child |
718 |
678 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,887 |
2,832 |
$8K |
| D7230 |
|
25 |
13 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
103 |
54 |
$4K |
| D1999 |
|
510 |
409 |
$2K |
| D0460 |
|
30 |
29 |
$101.85 |
| D9999 |
Unspecified adjunctive procedure, by report |
21 |
12 |
$100.00 |
| D0180 |
|
26 |
22 |
$0.00 |