| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,121 |
2,822 |
$385K |
| D1110 |
Prophylaxis - adult |
9,301 |
9,297 |
$364K |
| D0120 |
Periodic oral evaluation - established patient |
10,340 |
10,334 |
$220K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
439 |
370 |
$216K |
| D0274 |
Bitewings - four radiographic images |
10,077 |
10,076 |
$213K |
| D1351 |
Sealant - per tooth |
1,888 |
946 |
$123K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,449 |
901 |
$114K |
| D1120 |
Prophylaxis - child |
3,167 |
3,164 |
$107K |
| D0210 |
Intraoral - complete series of radiographic images |
3,822 |
3,803 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,452 |
2,452 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
6,960 |
6,949 |
$61K |
| D2954 |
|
482 |
398 |
$60K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,518 |
3,516 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
738 |
515 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,505 |
6,500 |
$31K |
| D2332 |
|
286 |
120 |
$23K |
| D1206 |
Topical application of fluoride varnish |
796 |
796 |
$19K |
| D0330 |
Panoramic radiographic image |
831 |
830 |
$12K |
| D3320 |
|
39 |
36 |
$11K |
| D0272 |
Bitewings - two radiographic images |
770 |
769 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
698 |
688 |
$7K |
| D9944 |
|
26 |
26 |
$3K |
| D2335 |
|
14 |
12 |
$915.75 |