| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
803 |
419 |
$121K |
| D2740 |
Crown - porcelain/ceramic |
169 |
144 |
$105K |
| D0140 |
Limited oral evaluation - problem focused |
1,230 |
1,166 |
$73K |
| D1110 |
Prophylaxis - adult |
816 |
729 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
445 |
233 |
$55K |
| D2950 |
|
252 |
199 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
545 |
503 |
$22K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
377 |
339 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
901 |
854 |
$20K |
| D0274 |
Bitewings - four radiographic images |
238 |
217 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
42 |
24 |
$10K |
| D1120 |
Prophylaxis - child |
142 |
137 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
99 |
87 |
$7K |
| D0330 |
Panoramic radiographic image |
66 |
53 |
$5K |
| D1206 |
Topical application of fluoride varnish |
179 |
172 |
$4K |
| D0270 |
|
131 |
127 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$3K |
| D4910 |
|
13 |
13 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14 |
13 |
$381.06 |