| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,338 |
736 |
$179K |
| D2740 |
Crown - porcelain/ceramic |
195 |
130 |
$108K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
635 |
380 |
$101K |
| D1110 |
Prophylaxis - adult |
2,038 |
2,023 |
$86K |
| D0120 |
Periodic oral evaluation - established patient |
2,872 |
2,855 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,907 |
1,896 |
$56K |
| D0330 |
Panoramic radiographic image |
1,050 |
1,040 |
$54K |
| D0140 |
Limited oral evaluation - problem focused |
887 |
879 |
$30K |
| D0220 |
Intraoral - periapical first radiographic image |
2,208 |
2,182 |
$27K |
| D0460 |
|
969 |
956 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
979 |
976 |
$25K |
| D2950 |
|
184 |
129 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
398 |
395 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
155 |
49 |
$15K |
| D2394 |
|
76 |
48 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
77 |
38 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
85 |
55 |
$9K |
| D2335 |
|
32 |
15 |
$5K |
| D4342 |
|
56 |
25 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
303 |
301 |
$4K |
| D1206 |
Topical application of fluoride varnish |
129 |
125 |
$3K |
| D0180 |
|
12 |
12 |
$487.20 |
| D1120 |
Prophylaxis - child |
12 |
12 |
$360.72 |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
31 |
$342.55 |