| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
881 |
570 |
$55K |
| D1110 |
Prophylaxis - adult |
1,066 |
1,045 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
1,532 |
1,504 |
$31K |
| D0274 |
Bitewings - four radiographic images |
968 |
951 |
$25K |
| D2740 |
Crown - porcelain/ceramic |
36 |
29 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
347 |
333 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
204 |
167 |
$13K |
| D1120 |
Prophylaxis - child |
349 |
345 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
437 |
433 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
147 |
105 |
$7K |
| D0272 |
Bitewings - two radiographic images |
321 |
318 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
691 |
646 |
$5K |
| D0330 |
Panoramic radiographic image |
126 |
124 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
90 |
84 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
142 |
128 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
27 |
27 |
$540.00 |
| D4910 |
|
12 |
12 |
$403.92 |