| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
537 |
395 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
601 |
370 |
$52K |
| D1110 |
Prophylaxis - adult |
923 |
901 |
$47K |
| D0140 |
Limited oral evaluation - problem focused |
1,090 |
1,056 |
$43K |
| D2740 |
Crown - porcelain/ceramic |
60 |
43 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
395 |
287 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
955 |
941 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
1,554 |
1,439 |
$22K |
| D1120 |
Prophylaxis - child |
321 |
320 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
86 |
65 |
$11K |
| D0274 |
Bitewings - four radiographic images |
331 |
329 |
$11K |
| D0330 |
Panoramic radiographic image |
170 |
169 |
$10K |
| D2940 |
|
113 |
87 |
$7K |
| D1206 |
Topical application of fluoride varnish |
253 |
253 |
$7K |
| D2331 |
|
37 |
24 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
404 |
306 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
109 |
95 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$996.00 |