| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,061 |
559 |
$132K |
| D2740 |
Crown - porcelain/ceramic |
109 |
64 |
$68K |
| D1110 |
Prophylaxis - adult |
1,226 |
1,226 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,310 |
2,309 |
$62K |
| D1120 |
Prophylaxis - child |
1,569 |
1,568 |
$62K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
297 |
171 |
$44K |
| D2950 |
|
207 |
110 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,417 |
1,417 |
$34K |
| D5225 |
|
37 |
37 |
$33K |
| D5226 |
|
34 |
34 |
$30K |
| D0274 |
Bitewings - four radiographic images |
852 |
850 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
334 |
334 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
1,541 |
1,532 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
252 |
176 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
518 |
518 |
$23K |
| D4341 |
|
133 |
44 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,077 |
1,218 |
$18K |
| D1206 |
Topical application of fluoride varnish |
439 |
439 |
$11K |
| D2710 |
|
22 |
12 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
117 |
116 |
$5K |
| D1352 |
|
61 |
25 |
$4K |
| D2394 |
|
19 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
31 |
31 |
$718.05 |