| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,819 |
1,075 |
$100K |
| D1110 |
Prophylaxis - adult |
3,821 |
3,767 |
$72K |
| D0120 |
Periodic oral evaluation - established patient |
3,216 |
3,171 |
$65K |
| D0330 |
Panoramic radiographic image |
3,130 |
3,064 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,038 |
2,000 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,031 |
573 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
2,339 |
2,276 |
$39K |
| D2750 |
|
109 |
85 |
$32K |
| D0274 |
Bitewings - four radiographic images |
2,948 |
2,898 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
6,426 |
6,202 |
$24K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
86 |
66 |
$23K |
| D2954 |
|
468 |
382 |
$21K |
| D4341 |
|
590 |
189 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,059 |
5,125 |
$19K |
| D1120 |
Prophylaxis - child |
1,086 |
1,066 |
$18K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
41 |
38 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
821 |
804 |
$7K |
| D0272 |
Bitewings - two radiographic images |
784 |
776 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
19 |
14 |
$560.00 |
| D0601 |
|
12 |
12 |
$120.00 |
| D1999 |
|
694 |
623 |
$0.00 |