| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
719 |
357 |
$79K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,240 |
1,185 |
$75K |
| D0210 |
Intraoral - complete series of radiographic images |
718 |
660 |
$58K |
| D2740 |
Crown - porcelain/ceramic |
93 |
54 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
368 |
181 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
415 |
387 |
$22K |
| D1110 |
Prophylaxis - adult |
430 |
406 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
176 |
77 |
$20K |
| D4341 |
|
115 |
58 |
$18K |
| D2950 |
|
133 |
92 |
$15K |
| D1206 |
Topical application of fluoride varnish |
629 |
609 |
$13K |
| D1120 |
Prophylaxis - child |
300 |
290 |
$10K |
| D0330 |
Panoramic radiographic image |
109 |
106 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
415 |
380 |
$8K |
| D0274 |
Bitewings - four radiographic images |
232 |
226 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
43 |
29 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
173 |
170 |
$5K |
| D1310 |
|
186 |
172 |
$4K |
| D4342 |
|
37 |
25 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
167 |
85 |
$2K |
| D1330 |
|
125 |
114 |
$2K |
| D1351 |
Sealant - per tooth |
55 |
12 |
$2K |
| D4346 |
|
27 |
26 |
$2K |
| D0460 |
|
48 |
31 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
109 |
109 |
$1K |
| D0270 |
|
58 |
57 |
$1K |
| D2940 |
|
19 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$957.15 |
| D3120 |
|
18 |
12 |
$697.17 |