| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,900 |
1,259 |
$244K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,283 |
1,250 |
$242K |
| D2740 |
Crown - porcelain/ceramic |
388 |
215 |
$222K |
| D1110 |
Prophylaxis - adult |
1,713 |
1,697 |
$76K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,120 |
2,098 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,429 |
1,311 |
$66K |
| D1120 |
Prophylaxis - child |
1,323 |
1,311 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,656 |
1,644 |
$43K |
| D2950 |
|
282 |
188 |
$40K |
| D0140 |
Limited oral evaluation - problem focused |
977 |
945 |
$34K |
| D0220 |
Intraoral - periapical first radiographic image |
2,611 |
2,473 |
$34K |
| D0274 |
Bitewings - four radiographic images |
1,036 |
1,024 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,080 |
1,567 |
$21K |
| D1206 |
Topical application of fluoride varnish |
838 |
831 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
148 |
108 |
$18K |
| D4341 |
|
138 |
48 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
221 |
149 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
641 |
639 |
$14K |
| D1351 |
Sealant - per tooth |
198 |
56 |
$5K |
| D4910 |
|
13 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$621.00 |
| D0270 |
|
24 |
24 |
$304.20 |