| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,420 |
832 |
$95K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
162 |
133 |
$77K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,186 |
640 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
977 |
976 |
$63K |
| D1110 |
Prophylaxis - adult |
668 |
664 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
952 |
951 |
$57K |
| D0350 |
|
4,873 |
1,878 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,446 |
2,410 |
$47K |
| D1120 |
Prophylaxis - child |
1,036 |
1,034 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
714 |
713 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,346 |
1,342 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,560 |
1,556 |
$18K |
| D4341 |
|
256 |
76 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
196 |
143 |
$16K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
99 |
59 |
$12K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
115 |
55 |
$8K |
| D9430 |
|
155 |
155 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
294 |
292 |
$4K |
| D4910 |
|
41 |
41 |
$3K |
| D2330 |
|
40 |
25 |
$3K |
| D4342 |
|
46 |
13 |
$2K |
| D2954 |
|
18 |
16 |
$2K |
| D2140 |
|
30 |
14 |
$2K |
| D0272 |
Bitewings - two radiographic images |
40 |
40 |
$456.00 |