| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
342 |
212 |
$28K |
| D1110 |
Prophylaxis - adult |
416 |
416 |
$24K |
| D2740 |
Crown - porcelain/ceramic |
27 |
15 |
$22K |
| D7140 |
Extraction, erupted tooth or exposed root |
227 |
112 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
179 |
132 |
$18K |
| D0274 |
Bitewings - four radiographic images |
381 |
375 |
$12K |
| D0330 |
Panoramic radiographic image |
167 |
166 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
398 |
393 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
144 |
88 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
210 |
208 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
885 |
590 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
775 |
763 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
180 |
178 |
$6K |
| D2394 |
|
18 |
15 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
43 |
43 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$1K |