| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,058 |
628 |
$94K |
| D2740 |
Crown - porcelain/ceramic |
118 |
82 |
$64K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
473 |
255 |
$59K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
79 |
73 |
$56K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
641 |
358 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,165 |
1,903 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
384 |
274 |
$50K |
| D2950 |
|
386 |
300 |
$46K |
| D1110 |
Prophylaxis - adult |
1,078 |
1,055 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,987 |
1,759 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,583 |
1,541 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
1,130 |
892 |
$31K |
| D0330 |
Panoramic radiographic image |
739 |
509 |
$23K |
| D2750 |
|
37 |
29 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,889 |
1,658 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
846 |
831 |
$15K |
| D4341 |
|
169 |
65 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,447 |
812 |
$12K |
| D1206 |
Topical application of fluoride varnish |
498 |
493 |
$10K |
| D1120 |
Prophylaxis - child |
280 |
280 |
$9K |
| D9920 |
|
84 |
83 |
$6K |
| D2331 |
|
39 |
26 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
178 |
178 |
$4K |
| D2332 |
|
18 |
13 |
$3K |
| D9994 |
|
46 |
46 |
$0.00 |