| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,399 |
520 |
$93K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,209 |
442 |
$66K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
944 |
931 |
$62K |
| D2740 |
Crown - porcelain/ceramic |
117 |
77 |
$56K |
| D0210 |
Intraoral - complete series of radiographic images |
800 |
787 |
$38K |
| D0350 |
|
5,055 |
979 |
$36K |
| D4910 |
|
395 |
394 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
349 |
187 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
331 |
326 |
$25K |
| D9430 |
|
602 |
570 |
$19K |
| D1120 |
Prophylaxis - child |
348 |
346 |
$18K |
| D4341 |
|
244 |
68 |
$17K |
| D1206 |
Topical application of fluoride varnish |
996 |
982 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,876 |
965 |
$17K |
| D2330 |
|
126 |
64 |
$10K |
| D0274 |
Bitewings - four radiographic images |
249 |
245 |
$5K |
| D2952 |
|
41 |
27 |
$4K |
| D0270 |
|
330 |
319 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
26 |
26 |
$312.00 |