| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
927 |
357 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,068 |
221 |
$110K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
772 |
306 |
$85K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
386 |
212 |
$65K |
| D0330 |
Panoramic radiographic image |
464 |
419 |
$23K |
| D2740 |
Crown - porcelain/ceramic |
58 |
50 |
$23K |
| D1110 |
Prophylaxis - adult |
466 |
421 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
491 |
444 |
$19K |
| D2330 |
|
171 |
60 |
$17K |
| D0274 |
Bitewings - four radiographic images |
490 |
454 |
$14K |
| D2950 |
|
91 |
74 |
$11K |
| D5110 |
|
14 |
14 |
$11K |
| D2335 |
|
61 |
29 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
445 |
401 |
$10K |
| D2752 |
|
19 |
14 |
$9K |
| D1120 |
Prophylaxis - child |
155 |
132 |
$5K |
| D1206 |
Topical application of fluoride varnish |
254 |
218 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
107 |
$4K |
| D2332 |
|
19 |
12 |
$3K |
| D2394 |
|
12 |
12 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
138 |
135 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
26 |
26 |
$559.80 |
| D0272 |
Bitewings - two radiographic images |
15 |
13 |
$303.30 |
| D0230 |
Intraoral - periapical each additional radiographic image |
13 |
13 |
$204.34 |