| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
434 |
186 |
$31K |
| D0330 |
Panoramic radiographic image |
508 |
507 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
246 |
113 |
$21K |
| D1110 |
Prophylaxis - adult |
470 |
465 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
753 |
747 |
$17K |
| D2740 |
Crown - porcelain/ceramic |
313 |
112 |
$14K |
| D1206 |
Topical application of fluoride varnish |
532 |
528 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$11K |
| D2950 |
|
319 |
169 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
590 |
586 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
55 |
28 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
606 |
396 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
53 |
$7K |
| D4341 |
|
87 |
28 |
$6K |
| D1120 |
Prophylaxis - child |
161 |
161 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
305 |
299 |
$5K |
| D0274 |
Bitewings - four radiographic images |
277 |
272 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
575 |
524 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
461 |
251 |
$1K |