| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,600 |
770 |
$102K |
| D1110 |
Prophylaxis - adult |
1,649 |
1,631 |
$43K |
| D2740 |
Crown - porcelain/ceramic |
317 |
220 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,117 |
1,107 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,259 |
1,247 |
$22K |
| D2950 |
|
466 |
350 |
$20K |
| D0330 |
Panoramic radiographic image |
681 |
677 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
371 |
209 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
95 |
53 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
352 |
279 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
911 |
895 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
73 |
53 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
226 |
215 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
300 |
300 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
451 |
435 |
$3K |
| D9110 |
|
80 |
77 |
$0.00 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$0.00 |