| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,507 |
6,394 |
$242K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,635 |
1,088 |
$175K |
| D0120 |
Periodic oral evaluation - established patient |
6,869 |
6,779 |
$131K |
| D2394 |
|
1,654 |
964 |
$127K |
| D0330 |
Panoramic radiographic image |
2,391 |
2,368 |
$124K |
| D2740 |
Crown - porcelain/ceramic |
135 |
78 |
$114K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,936 |
5,863 |
$99K |
| D0274 |
Bitewings - four radiographic images |
3,976 |
3,926 |
$87K |
| D1120 |
Prophylaxis - child |
3,934 |
3,904 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,458 |
2,426 |
$67K |
| D2335 |
|
499 |
245 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
653 |
310 |
$41K |
| D1351 |
Sealant - per tooth |
1,694 |
327 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,146 |
3,035 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
4,283 |
4,042 |
$24K |
| D2332 |
|
302 |
165 |
$20K |
| D2160 |
|
308 |
103 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,348 |
1,333 |
$14K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
29 |
26 |
$11K |
| D0140 |
Limited oral evaluation - problem focused |
411 |
405 |
$11K |
| D2161 |
|
125 |
73 |
$9K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
185 |
89 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
27 |
14 |
$1K |
| D2951 |
|
58 |
26 |
$939.93 |
| D1320 |
|
37 |
37 |
$396.90 |