| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
792 |
445 |
$60K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
405 |
243 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
636 |
600 |
$39K |
| D1110 |
Prophylaxis - adult |
999 |
941 |
$38K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
426 |
269 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
529 |
300 |
$33K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
36 |
29 |
$26K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
48 |
42 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,052 |
1,005 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
816 |
771 |
$24K |
| D2954 |
|
145 |
121 |
$22K |
| D0274 |
Bitewings - four radiographic images |
574 |
556 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
565 |
448 |
$19K |
| D2335 |
|
131 |
83 |
$17K |
| D1206 |
Topical application of fluoride varnish |
809 |
758 |
$16K |
| D2394 |
|
129 |
83 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
201 |
95 |
$15K |
| D2332 |
|
139 |
91 |
$15K |
| D1120 |
Prophylaxis - child |
331 |
321 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
829 |
782 |
$10K |
| D7250 |
|
49 |
26 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
279 |
275 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
24 |
16 |
$282.20 |