| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
808 |
402 |
$61K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
298 |
117 |
$39K |
| D0210 |
Intraoral - complete series of radiographic images |
404 |
392 |
$22K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
340 |
192 |
$21K |
| D2740 |
Crown - porcelain/ceramic |
33 |
27 |
$19K |
| D1110 |
Prophylaxis - adult |
429 |
419 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
164 |
113 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
505 |
490 |
$15K |
| D4342 |
|
299 |
88 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
334 |
327 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
375 |
340 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
174 |
169 |
$3K |
| D2331 |
|
40 |
27 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
115 |
112 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
60 |
54 |
$2K |
| D0274 |
Bitewings - four radiographic images |
42 |
40 |
$1K |
| D0330 |
Panoramic radiographic image |
43 |
40 |
$343.33 |
| D4355 |
|
17 |
15 |
$0.00 |