| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
540 |
309 |
$70K |
| D1110 |
Prophylaxis - adult |
1,322 |
1,292 |
$67K |
| D2740 |
Crown - porcelain/ceramic |
73 |
59 |
$38K |
| D0210 |
Intraoral - complete series of radiographic images |
477 |
458 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
838 |
805 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
902 |
887 |
$22K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
41 |
38 |
$21K |
| D2950 |
|
185 |
157 |
$20K |
| D0274 |
Bitewings - four radiographic images |
431 |
417 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
139 |
94 |
$9K |
| D4341 |
|
53 |
29 |
$7K |
| D4910 |
|
83 |
81 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
299 |
269 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
123 |
118 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
25 |
12 |
$3K |
| D1206 |
Topical application of fluoride varnish |
124 |
120 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$2K |
| D0270 |
|
204 |
171 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
12 |
$96.47 |