| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,974 |
1,156 |
$262K |
| D2740 |
Crown - porcelain/ceramic |
276 |
184 |
$161K |
| D1110 |
Prophylaxis - adult |
3,246 |
3,232 |
$144K |
| D0330 |
Panoramic radiographic image |
2,335 |
2,323 |
$120K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,128 |
657 |
$116K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,374 |
2,364 |
$94K |
| D0274 |
Bitewings - four radiographic images |
2,460 |
2,450 |
$72K |
| D2991 |
|
1,142 |
109 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,432 |
2,425 |
$57K |
| D7140 |
Extraction, erupted tooth or exposed root |
562 |
241 |
$53K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
312 |
225 |
$48K |
| D0140 |
Limited oral evaluation - problem focused |
1,175 |
1,155 |
$40K |
| D4910 |
|
382 |
381 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,297 |
1,272 |
$16K |
| D2950 |
|
79 |
60 |
$10K |
| D0350 |
|
188 |
184 |
$7K |
| D0460 |
|
159 |
157 |
$4K |
| D4342 |
|
34 |
12 |
$3K |
| D1120 |
Prophylaxis - child |
76 |
76 |
$2K |
| D2331 |
|
18 |
13 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
50 |
50 |
$1K |
| D4346 |
|
13 |
13 |
$602.23 |
| D1206 |
Topical application of fluoride varnish |
18 |
18 |
$311.45 |