| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
8,816 |
2,692 |
$470K |
| D1110 |
Prophylaxis - adult |
4,314 |
4,300 |
$372K |
| D0120 |
Periodic oral evaluation - established patient |
5,770 |
5,741 |
$356K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,644 |
4,631 |
$299K |
| D1120 |
Prophylaxis - child |
5,567 |
5,534 |
$230K |
| D0210 |
Intraoral - complete series of radiographic images |
4,183 |
4,170 |
$194K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,394 |
1,210 |
$158K |
| D2740 |
Crown - porcelain/ceramic |
332 |
239 |
$158K |
| D1206 |
Topical application of fluoride varnish |
9,850 |
9,792 |
$143K |
| D1351 |
Sealant - per tooth |
4,651 |
1,371 |
$133K |
| D0274 |
Bitewings - four radiographic images |
4,855 |
4,832 |
$101K |
| D2330 |
|
1,304 |
697 |
$98K |
| D9430 |
|
2,727 |
2,574 |
$86K |
| D0350 |
|
7,541 |
2,862 |
$79K |
| D4910 |
|
891 |
888 |
$68K |
| D4341 |
|
923 |
250 |
$65K |
| D0230 |
Intraoral - periapical each additional radiographic image |
14,725 |
8,256 |
$59K |
| D1320 |
|
2,650 |
2,641 |
$44K |
| D2954 |
|
140 |
102 |
$15K |
| D0272 |
Bitewings - two radiographic images |
759 |
752 |
$9K |
| D1310 |
|
112 |
112 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
300 |
295 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
39 |
27 |
$3K |
| D0603 |
|
112 |
112 |
$2K |
| D9993 |
|
13 |
13 |
$0.00 |