| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,318 |
661 |
$159K |
| D1120 |
Prophylaxis - child |
1,768 |
1,768 |
$74K |
| D1110 |
Prophylaxis - adult |
1,704 |
1,700 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
2,797 |
2,791 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,319 |
2,311 |
$72K |
| D7140 |
Extraction, erupted tooth or exposed root |
895 |
527 |
$71K |
| D0330 |
Panoramic radiographic image |
1,081 |
1,078 |
$65K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
703 |
367 |
$65K |
| D1206 |
Topical application of fluoride varnish |
2,220 |
2,220 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,536 |
1,526 |
$49K |
| D0274 |
Bitewings - four radiographic images |
1,661 |
1,656 |
$40K |
| D4341 |
|
203 |
77 |
$30K |
| D2950 |
|
175 |
140 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,443 |
2,410 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,921 |
1,375 |
$10K |
| D2740 |
Crown - porcelain/ceramic |
17 |
12 |
$8K |
| D4355 |
|
50 |
50 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$2K |
| D9986 |
|
51 |
51 |
$0.00 |