| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,519 |
2,203 |
$594K |
| D2740 |
Crown - porcelain/ceramic |
403 |
201 |
$301K |
| D1110 |
Prophylaxis - adult |
4,186 |
4,166 |
$189K |
| D0120 |
Periodic oral evaluation - established patient |
6,594 |
6,551 |
$156K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,413 |
3,404 |
$138K |
| D0210 |
Intraoral - complete series of radiographic images |
1,738 |
1,728 |
$137K |
| D0274 |
Bitewings - four radiographic images |
3,616 |
3,603 |
$107K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
592 |
367 |
$95K |
| D0220 |
Intraoral - periapical first radiographic image |
5,964 |
5,889 |
$75K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,809 |
3,794 |
$54K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
520 |
326 |
$53K |
| D4341 |
|
224 |
81 |
$53K |
| D0140 |
Limited oral evaluation - problem focused |
1,540 |
1,533 |
$53K |
| D4910 |
|
641 |
636 |
$47K |
| D4342 |
|
472 |
182 |
$43K |
| D1206 |
Topical application of fluoride varnish |
1,638 |
1,631 |
$33K |
| D2950 |
|
213 |
111 |
$28K |
| D1120 |
Prophylaxis - child |
370 |
361 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
76 |
37 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
216 |
207 |
$2K |
| D0330 |
Panoramic radiographic image |
18 |
18 |
$945.90 |