| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,295 |
603 |
$71K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
991 |
457 |
$51K |
| D0330 |
Panoramic radiographic image |
1,071 |
969 |
$38K |
| D2740 |
Crown - porcelain/ceramic |
319 |
159 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,298 |
1,187 |
$28K |
| D1110 |
Prophylaxis - adult |
953 |
938 |
$27K |
| D7880 |
|
130 |
123 |
$21K |
| D0274 |
Bitewings - four radiographic images |
927 |
901 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,035 |
969 |
$16K |
| D4355 |
|
222 |
218 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
853 |
846 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,133 |
942 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
195 |
93 |
$6K |
| D4341 |
|
401 |
140 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
578 |
572 |
$6K |
| D1120 |
Prophylaxis - child |
359 |
356 |
$5K |
| D9630 |
|
564 |
528 |
$5K |
| D4910 |
|
291 |
289 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
191 |
178 |
$5K |
| D3120 |
|
23 |
12 |
$502.53 |
| D0230 |
Intraoral - periapical each additional radiographic image |
21 |
17 |
$0.00 |
| D9610 |
|
226 |
201 |
$0.00 |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
28 |
$0.00 |
| D2950 |
|
250 |
143 |
$0.00 |