| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,451 |
757 |
$198K |
| D2740 |
Crown - porcelain/ceramic |
296 |
216 |
$160K |
| D1110 |
Prophylaxis - adult |
2,000 |
1,995 |
$89K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,033 |
2,010 |
$79K |
| D0210 |
Intraoral - complete series of radiographic images |
782 |
767 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
274 |
176 |
$45K |
| D7140 |
Extraction, erupted tooth or exposed root |
415 |
153 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,636 |
1,627 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,267 |
1,259 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
314 |
181 |
$33K |
| D0140 |
Limited oral evaluation - problem focused |
827 |
816 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
139 |
85 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,409 |
1,377 |
$17K |
| D2950 |
|
78 |
65 |
$10K |
| D4341 |
|
36 |
12 |
$10K |
| D2750 |
|
15 |
14 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
240 |
237 |
$4K |
| D4342 |
|
40 |
14 |
$4K |
| D2394 |
|
19 |
12 |
$4K |
| D1206 |
Topical application of fluoride varnish |
186 |
181 |
$3K |
| D0330 |
Panoramic radiographic image |
28 |
28 |
$1K |
| D1120 |
Prophylaxis - child |
22 |
22 |
$715.14 |