| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,921 |
1,030 |
$290K |
| D2740 |
Crown - porcelain/ceramic |
278 |
244 |
$181K |
| D1110 |
Prophylaxis - adult |
2,213 |
2,045 |
$174K |
| D0330 |
Panoramic radiographic image |
1,711 |
1,591 |
$151K |
| D2950 |
|
824 |
679 |
$144K |
| D0140 |
Limited oral evaluation - problem focused |
2,119 |
1,962 |
$125K |
| D0274 |
Bitewings - four radiographic images |
2,155 |
1,989 |
$116K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
939 |
526 |
$115K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,852 |
1,698 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
291 |
194 |
$54K |
| D0220 |
Intraoral - periapical first radiographic image |
1,826 |
1,698 |
$41K |
| D0120 |
Periodic oral evaluation - established patient |
957 |
880 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
57 |
13 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
134 |
115 |
$10K |
| D0270 |
|
237 |
210 |
$5K |
| D4212 |
|
130 |
116 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
125 |
118 |
$3K |
| D4910 |
|
33 |
31 |
$3K |
| D1120 |
Prophylaxis - child |
43 |
40 |
$2K |
| D2330 |
|
28 |
15 |
$2K |
| D4346 |
|
12 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18 |
12 |
$351.77 |