| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,094 |
839 |
$206K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,578 |
766 |
$152K |
| D2740 |
Crown - porcelain/ceramic |
124 |
42 |
$76K |
| D2950 |
|
420 |
206 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,825 |
1,788 |
$43K |
| D1110 |
Prophylaxis - adult |
1,307 |
1,283 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,065 |
1,049 |
$20K |
| D3320 |
|
36 |
26 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,694 |
1,209 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
761 |
758 |
$17K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
12 |
$13K |
| D1120 |
Prophylaxis - child |
373 |
364 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,348 |
1,332 |
$10K |
| D0272 |
Bitewings - two radiographic images |
354 |
338 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
465 |
463 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
234 |
230 |
$5K |
| D0274 |
Bitewings - four radiographic images |
311 |
302 |
$4K |
| D0330 |
Panoramic radiographic image |
59 |
47 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
14 |
$3K |
| D2330 |
|
20 |
12 |
$2K |