| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
959 |
585 |
$59K |
| D1110 |
Prophylaxis - adult |
1,645 |
1,598 |
$58K |
| D0330 |
Panoramic radiographic image |
907 |
814 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,335 |
1,217 |
$32K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
487 |
318 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
303 |
82 |
$32K |
| D2740 |
Crown - porcelain/ceramic |
69 |
58 |
$14K |
| D0274 |
Bitewings - four radiographic images |
637 |
631 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
812 |
800 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
717 |
638 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,247 |
1,192 |
$8K |
| D2950 |
|
126 |
94 |
$8K |
| D9994 |
|
492 |
480 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
663 |
560 |
$3K |
| D1120 |
Prophylaxis - child |
121 |
119 |
$3K |
| D9992 |
|
284 |
273 |
$2K |
| D1206 |
Topical application of fluoride varnish |
158 |
156 |
$2K |
| D4341 |
|
96 |
40 |
$0.00 |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
41 |
$0.00 |
| D2394 |
|
15 |
12 |
$0.00 |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
56 |
$0.00 |
| D9630 |
|
37 |
35 |
$0.00 |