| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,684 |
1,003 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,387 |
873 |
$83K |
| D1110 |
Prophylaxis - adult |
1,989 |
1,964 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
4,293 |
4,259 |
$70K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,574 |
3,536 |
$68K |
| D0274 |
Bitewings - four radiographic images |
2,908 |
2,873 |
$64K |
| D1120 |
Prophylaxis - child |
1,995 |
1,983 |
$61K |
| D4341 |
|
1,153 |
359 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,836 |
1,594 |
$45K |
| D4910 |
|
1,042 |
1,036 |
$39K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,565 |
3,210 |
$39K |
| D4342 |
|
754 |
199 |
$37K |
| D0220 |
Intraoral - periapical first radiographic image |
4,237 |
3,885 |
$36K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
67 |
56 |
$34K |
| D0330 |
Panoramic radiographic image |
765 |
606 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
492 |
450 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
626 |
565 |
$12K |
| D1351 |
Sealant - per tooth |
375 |
128 |
$11K |
| D2950 |
|
82 |
68 |
$10K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
16 |
$2K |
| D9994 |
|
48 |
48 |
$339.48 |
| D9630 |
|
12 |
12 |
$309.96 |
| D0272 |
Bitewings - two radiographic images |
16 |
12 |
$261.95 |
| D1206 |
Topical application of fluoride varnish |
131 |
131 |
$135.15 |