| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
515 |
492 |
$87K |
| D2740 |
Crown - porcelain/ceramic |
64 |
44 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
443 |
199 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
276 |
157 |
$38K |
| D0330 |
Panoramic radiographic image |
502 |
501 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
437 |
436 |
$22K |
| D1110 |
Prophylaxis - adult |
283 |
281 |
$21K |
| D0274 |
Bitewings - four radiographic images |
364 |
364 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
183 |
182 |
$8K |
| D0460 |
|
274 |
260 |
$8K |
| D1206 |
Topical application of fluoride varnish |
166 |
165 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
19 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
29 |
13 |
$5K |