| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,788 |
1,311 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
1,992 |
1,992 |
$40K |
| D1110 |
Prophylaxis - adult |
1,384 |
1,383 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
685 |
531 |
$25K |
| D0140 |
Limited oral evaluation - problem focused |
670 |
655 |
$13K |
| D0274 |
Bitewings - four radiographic images |
1,414 |
1,413 |
$12K |
| D1120 |
Prophylaxis - child |
517 |
517 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
2,356 |
2,320 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,398 |
1,390 |
$8K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
12 |
12 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
449 |
449 |
$3K |
| D0270 |
|
708 |
671 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
98 |
98 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
40 |
$2K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
43 |
34 |
$2K |
| D0272 |
Bitewings - two radiographic images |
281 |
280 |
$1K |
| D0330 |
Panoramic radiographic image |
16 |
16 |
$320.00 |
| D1999 |
|
27 |
27 |
$0.00 |