| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
626 |
261 |
$64K |
| D0210 |
Intraoral - complete series of radiographic images |
430 |
429 |
$50K |
| D2740 |
Crown - porcelain/ceramic |
46 |
32 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
594 |
593 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
191 |
104 |
$24K |
| D1110 |
Prophylaxis - adult |
336 |
334 |
$22K |
| D0330 |
Panoramic radiographic image |
120 |
120 |
$10K |
| D2335 |
|
36 |
28 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
32 |
14 |
$3K |
| D1120 |
Prophylaxis - child |
36 |
36 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$555.95 |
| D0120 |
Periodic oral evaluation - established patient |
12 |
12 |
$402.72 |
| D1206 |
Topical application of fluoride varnish |
12 |
12 |
$353.76 |