| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
9,463 |
2,499 |
$368K |
| D1110 |
Prophylaxis - adult |
4,659 |
4,475 |
$78K |
| D2335 |
|
1,383 |
315 |
$71K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,169 |
1,000 |
$70K |
| D2740 |
Crown - porcelain/ceramic |
285 |
149 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,373 |
3,301 |
$58K |
| D4341 |
|
1,665 |
497 |
$52K |
| D0210 |
Intraoral - complete series of radiographic images |
1,528 |
1,512 |
$49K |
| D0120 |
Periodic oral evaluation - established patient |
2,177 |
2,087 |
$41K |
| D2394 |
|
1,057 |
364 |
$30K |
| D0274 |
Bitewings - four radiographic images |
3,990 |
3,516 |
$24K |
| D4210 |
|
416 |
100 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
1,071 |
998 |
$17K |
| D0330 |
Panoramic radiographic image |
2,574 |
2,301 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
251 |
149 |
$9K |
| D1120 |
Prophylaxis - child |
431 |
429 |
$8K |
| D2750 |
|
17 |
12 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
1,628 |
1,314 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,405 |
1,096 |
$3K |
| D1206 |
Topical application of fluoride varnish |
201 |
201 |
$2K |
| D0603 |
|
109 |
109 |
$920.00 |
| D2950 |
|
28 |
18 |
$540.00 |