| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
533 |
527 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
443 |
248 |
$30K |
| D1110 |
Prophylaxis - adult |
300 |
297 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
368 |
364 |
$17K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
26 |
17 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
115 |
66 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
585 |
580 |
$8K |
| D1320 |
|
327 |
327 |
$6K |
| D1120 |
Prophylaxis - child |
72 |
72 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
694 |
197 |
$3K |
| D9430 |
|
43 |
41 |
$1K |
| D0274 |
Bitewings - four radiographic images |
26 |
26 |
$518.40 |
| D1330 |
|
29 |
29 |
$0.00 |