| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,233 |
483 |
$184K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
603 |
210 |
$146K |
| D0140 |
Limited oral evaluation - problem focused |
1,362 |
1,160 |
$79K |
| D0330 |
Panoramic radiographic image |
964 |
832 |
$78K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
361 |
209 |
$75K |
| D0274 |
Bitewings - four radiographic images |
999 |
874 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
384 |
187 |
$48K |
| D1110 |
Prophylaxis - adult |
668 |
572 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
331 |
84 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,697 |
1,109 |
$44K |
| D0220 |
Intraoral - periapical first radiographic image |
2,025 |
1,720 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
761 |
663 |
$42K |
| D2740 |
Crown - porcelain/ceramic |
32 |
24 |
$19K |
| D1206 |
Topical application of fluoride varnish |
597 |
531 |
$14K |
| D2332 |
|
75 |
45 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
295 |
274 |
$13K |
| D2394 |
|
31 |
25 |
$7K |
| D2331 |
|
28 |
18 |
$3K |
| D1120 |
Prophylaxis - child |
28 |
26 |
$1K |