| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,255 |
636 |
$150K |
| D2740 |
Crown - porcelain/ceramic |
244 |
204 |
$146K |
| D1110 |
Prophylaxis - adult |
2,171 |
2,063 |
$107K |
| D0330 |
Panoramic radiographic image |
1,435 |
1,359 |
$74K |
| D0274 |
Bitewings - four radiographic images |
2,116 |
2,015 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,540 |
1,431 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,470 |
1,393 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,052 |
960 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
969 |
854 |
$14K |
| D2950 |
|
106 |
96 |
$13K |
| D1206 |
Topical application of fluoride varnish |
272 |
261 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
25 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
61 |
39 |
$3K |
| D4910 |
|
26 |
24 |
$2K |