| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2332 |
|
2,591 |
1,282 |
$190K |
| D2331 |
|
1,867 |
1,363 |
$155K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,762 |
1,319 |
$138K |
| D1110 |
Prophylaxis - adult |
3,389 |
3,384 |
$121K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,180 |
1,471 |
$104K |
| D0120 |
Periodic oral evaluation - established patient |
2,413 |
2,410 |
$48K |
| D0274 |
Bitewings - four radiographic images |
2,416 |
2,416 |
$46K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
87 |
63 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,007 |
2,994 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
805 |
802 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
983 |
983 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,814 |
2,810 |
$14K |
| D2954 |
|
135 |
91 |
$13K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
16 |
12 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
90 |
90 |
$991.30 |