| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9944 |
|
694 |
662 |
$154K |
| D1351 |
Sealant - per tooth |
3,738 |
623 |
$133K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,156 |
615 |
$126K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,123 |
519 |
$99K |
| D2740 |
Crown - porcelain/ceramic |
150 |
105 |
$95K |
| D1110 |
Prophylaxis - adult |
2,081 |
2,066 |
$93K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,970 |
2,918 |
$74K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
522 |
305 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
2,363 |
2,355 |
$66K |
| D0210 |
Intraoral - complete series of radiographic images |
926 |
926 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,511 |
1,454 |
$47K |
| D1120 |
Prophylaxis - child |
1,186 |
1,184 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,142 |
1,124 |
$37K |
| D1999 |
|
2,797 |
2,408 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,774 |
1,756 |
$25K |
| D2950 |
|
129 |
91 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,591 |
2,526 |
$17K |
| D0330 |
Panoramic radiographic image |
1,286 |
1,269 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,787 |
1,903 |
$16K |
| D1206 |
Topical application of fluoride varnish |
377 |
375 |
$15K |
| D5211 |
|
13 |
12 |
$11K |
| D4341 |
|
33 |
13 |
$6K |
| D0272 |
Bitewings - two radiographic images |
332 |
332 |
$5K |
| D2394 |
|
19 |
13 |
$4K |