| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
470 |
276 |
$55K |
| D0330 |
Panoramic radiographic image |
872 |
865 |
$54K |
| D1110 |
Prophylaxis - adult |
961 |
954 |
$49K |
| D7140 |
Extraction, erupted tooth or exposed root |
580 |
243 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
966 |
960 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,150 |
1,144 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,671 |
1,632 |
$23K |
| D0120 |
Periodic oral evaluation - established patient |
828 |
825 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
169 |
131 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
147 |
115 |
$21K |
| D4341 |
|
137 |
45 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
213 |
142 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
449 |
445 |
$18K |
| D3320 |
|
37 |
34 |
$18K |
| D1120 |
Prophylaxis - child |
417 |
417 |
$17K |
| D1206 |
Topical application of fluoride varnish |
516 |
516 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,545 |
1,338 |
$12K |
| D2950 |
|
67 |
62 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
15 |
13 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$8K |
| D4910 |
|
47 |
47 |
$4K |
| D4346 |
|
36 |
36 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
76 |
48 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
14 |
14 |
$410.00 |