| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,091 |
1,341 |
$229K |
| D1110 |
Prophylaxis - adult |
3,171 |
3,013 |
$131K |
| D0330 |
Panoramic radiographic image |
2,305 |
2,175 |
$122K |
| D0240 |
|
8,898 |
3,725 |
$114K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,601 |
838 |
$111K |
| D2740 |
Crown - porcelain/ceramic |
130 |
77 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
3,599 |
3,409 |
$74K |
| D2332 |
|
789 |
296 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,788 |
2,632 |
$67K |
| D0140 |
Limited oral evaluation - problem focused |
2,229 |
2,063 |
$59K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,766 |
1,667 |
$53K |
| D1206 |
Topical application of fluoride varnish |
2,766 |
2,621 |
$51K |
| D1120 |
Prophylaxis - child |
1,943 |
1,831 |
$47K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
608 |
353 |
$45K |
| D2140 |
|
523 |
121 |
$22K |
| D0272 |
Bitewings - two radiographic images |
1,400 |
1,316 |
$17K |
| D2752 |
|
34 |
12 |
$15K |
| D2950 |
|
52 |
41 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
135 |
71 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
842 |
736 |
$6K |
| D2954 |
|
34 |
12 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
351 |
315 |
$2K |
| D1351 |
Sealant - per tooth |
56 |
13 |
$1K |