| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,281 |
637 |
$28K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
793 |
446 |
$28K |
| D0274 |
Bitewings - four radiographic images |
3,685 |
3,510 |
$25K |
| D0330 |
Panoramic radiographic image |
1,979 |
1,838 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
5,635 |
5,203 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
1,985 |
1,775 |
$16K |
| D1110 |
Prophylaxis - adult |
1,487 |
1,448 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,631 |
4,238 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,402 |
3,311 |
$14K |
| D1120 |
Prophylaxis - child |
1,648 |
1,594 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
2,539 |
2,478 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
707 |
677 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
384 |
210 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
24 |
16 |
$3K |
| D2950 |
|
94 |
75 |
$2K |
| D0270 |
|
308 |
273 |
$703.91 |
| D2751 |
Crown - porcelain fused to predominantly base metal |
16 |
12 |
$518.00 |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
41 |
$388.50 |
| D0272 |
Bitewings - two radiographic images |
122 |
121 |
$302.67 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
14 |
12 |
$177.40 |
| D4910 |
|
15 |
14 |
$50.00 |
| D1999 |
|
1,201 |
1,086 |
$26.00 |