| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,394 |
610 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
996 |
996 |
$65K |
| D1110 |
Prophylaxis - adult |
569 |
569 |
$46K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
586 |
344 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
970 |
970 |
$41K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
696 |
374 |
$37K |
| D2740 |
Crown - porcelain/ceramic |
36 |
17 |
$17K |
| D0350 |
|
1,692 |
976 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
124 |
38 |
$15K |
| D9430 |
|
434 |
379 |
$14K |
| D1320 |
|
825 |
825 |
$13K |
| D1206 |
Topical application of fluoride varnish |
763 |
763 |
$12K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
12 |
$6K |
| D0330 |
Panoramic radiographic image |
225 |
225 |
$5K |
| D4341 |
|
74 |
26 |
$5K |
| D4342 |
|
77 |
25 |
$3K |
| D1120 |
Prophylaxis - child |
65 |
65 |
$3K |
| D0270 |
|
45 |
44 |
$220.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
22 |
16 |
$89.10 |