| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,803 |
1,300 |
$184K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,264 |
1,053 |
$171K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,392 |
2,375 |
$149K |
| D1110 |
Prophylaxis - adult |
1,444 |
1,435 |
$117K |
| D0210 |
Intraoral - complete series of radiographic images |
2,243 |
2,230 |
$100K |
| D4910 |
|
637 |
635 |
$47K |
| D4341 |
|
686 |
195 |
$40K |
| D1206 |
Topical application of fluoride varnish |
2,346 |
2,333 |
$35K |
| D0120 |
Periodic oral evaluation - established patient |
563 |
550 |
$33K |
| D2740 |
Crown - porcelain/ceramic |
51 |
41 |
$24K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,083 |
1,099 |
$20K |
| D1120 |
Prophylaxis - child |
437 |
435 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
172 |
115 |
$14K |
| D0274 |
Bitewings - four radiographic images |
637 |
622 |
$10K |
| D0350 |
|
854 |
253 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
59 |
28 |
$6K |
| D9430 |
|
119 |
111 |
$4K |
| D2330 |
|
24 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
19 |
13 |
$50.00 |