| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
897 |
894 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
304 |
201 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
432 |
430 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
877 |
873 |
$35K |
| D4910 |
|
437 |
435 |
$33K |
| D2740 |
Crown - porcelain/ceramic |
69 |
44 |
$31K |
| D2950 |
|
233 |
192 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
149 |
106 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
941 |
937 |
$23K |
| D7140 |
Extraction, erupted tooth or exposed root |
263 |
100 |
$23K |
| D4342 |
|
236 |
78 |
$22K |
| D2750 |
|
46 |
42 |
$20K |
| D0274 |
Bitewings - four radiographic images |
531 |
530 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
100 |
68 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
437 |
435 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
574 |
569 |
$7K |
| D0330 |
Panoramic radiographic image |
129 |
129 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
87 |
87 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
39 |
39 |
$627.57 |