| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
519 |
506 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
204 |
109 |
$12K |
| D1110 |
Prophylaxis - adult |
354 |
341 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,423 |
796 |
$11K |
| D0274 |
Bitewings - four radiographic images |
555 |
543 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
15 |
12 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,208 |
1,156 |
$10K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
70 |
25 |
$9K |
| D9630 |
|
508 |
489 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
552 |
541 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
744 |
381 |
$7K |
| D1206 |
Topical application of fluoride varnish |
388 |
374 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
262 |
254 |
$4K |
| D0330 |
Panoramic radiographic image |
44 |
44 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
77 |
31 |
$3K |
| D1120 |
Prophylaxis - child |
41 |
41 |
$925.20 |
| D3120 |
|
22 |
12 |
$526.46 |