| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
594 |
307 |
$41K |
| D2950 |
|
418 |
351 |
$34K |
| D1110 |
Prophylaxis - adult |
976 |
945 |
$32K |
| D2740 |
Crown - porcelain/ceramic |
79 |
62 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
512 |
493 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
757 |
742 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
42 |
41 |
$14K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
645 |
606 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
575 |
553 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
172 |
100 |
$12K |
| D2332 |
|
154 |
84 |
$11K |
| D1206 |
Topical application of fluoride varnish |
408 |
382 |
$8K |
| D0274 |
Bitewings - four radiographic images |
746 |
717 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
1,433 |
1,301 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
65 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,682 |
788 |
$4K |
| D0330 |
Panoramic radiographic image |
782 |
738 |
$4K |
| D1120 |
Prophylaxis - child |
157 |
152 |
$4K |
| D0272 |
Bitewings - two radiographic images |
247 |
233 |
$2K |
| D2335 |
|
21 |
12 |
$2K |
| D1999 |
|
93 |
83 |
$770.00 |
| D0270 |
|
162 |
154 |
$666.54 |
| D1208 |
Topical application of fluoride, excluding varnish |
28 |
28 |
$504.00 |