| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
807 |
462 |
$63K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,982 |
1,923 |
$51K |
| D1110 |
Prophylaxis - adult |
1,064 |
1,051 |
$46K |
| D0210 |
Intraoral - complete series of radiographic images |
1,837 |
1,509 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
2,438 |
2,333 |
$42K |
| D7880 |
|
136 |
136 |
$38K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,982 |
1,942 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,663 |
1,643 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
464 |
254 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
432 |
167 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,926 |
2,687 |
$27K |
| D0330 |
Panoramic radiographic image |
483 |
466 |
$23K |
| D2740 |
Crown - porcelain/ceramic |
33 |
26 |
$21K |
| D2950 |
|
130 |
98 |
$16K |
| D9994 |
|
2,173 |
2,156 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
839 |
828 |
$12K |
| D5110 |
|
16 |
13 |
$10K |
| D4355 |
|
343 |
341 |
$10K |
| D4342 |
|
157 |
42 |
$9K |
| D4910 |
|
67 |
67 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
41 |
$5K |
| D2332 |
|
21 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
69 |
69 |
$2K |
| D3221 |
|
20 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
74 |
74 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
13 |
$566.54 |
| D9630 |
|
14 |
14 |
$361.62 |
| D4341 |
|
33 |
12 |
$0.00 |