| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,923 |
1,009 |
$212K |
| D1110 |
Prophylaxis - adult |
2,007 |
1,996 |
$93K |
| D0120 |
Periodic oral evaluation - established patient |
2,793 |
2,785 |
$68K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
792 |
466 |
$65K |
| D2740 |
Crown - porcelain/ceramic |
88 |
77 |
$55K |
| D1120 |
Prophylaxis - child |
1,321 |
1,317 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
840 |
837 |
$32K |
| D0274 |
Bitewings - four radiographic images |
836 |
832 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
791 |
787 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
264 |
262 |
$16K |
| D1206 |
Topical application of fluoride varnish |
708 |
703 |
$15K |
| D0140 |
Limited oral evaluation - problem focused |
358 |
352 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
93 |
63 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
938 |
918 |
$12K |
| D0330 |
Panoramic radiographic image |
277 |
277 |
$10K |
| D2950 |
|
51 |
39 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
693 |
465 |
$5K |
| D0272 |
Bitewings - two radiographic images |
38 |
38 |
$591.37 |