| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
648 |
352 |
$48K |
| D0210 |
Intraoral - complete series of radiographic images |
586 |
578 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
670 |
298 |
$47K |
| D2740 |
Crown - porcelain/ceramic |
44 |
26 |
$36K |
| D1110 |
Prophylaxis - adult |
739 |
737 |
$35K |
| D2950 |
|
339 |
173 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
754 |
749 |
$26K |
| D1320 |
|
869 |
862 |
$20K |
| D1321 |
|
870 |
861 |
$20K |
| D2931 |
|
137 |
95 |
$18K |
| D0470 |
|
592 |
589 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
135 |
72 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
369 |
363 |
$10K |
| D0274 |
Bitewings - four radiographic images |
303 |
301 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
643 |
612 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
192 |
191 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
611 |
406 |
$4K |
| D1120 |
Prophylaxis - child |
100 |
98 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
12 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
86 |
84 |
$2K |
| D1206 |
Topical application of fluoride varnish |
25 |
24 |
$360.00 |