| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
11,927 |
3,011 |
$109K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,112 |
603 |
$74K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,107 |
1,101 |
$73K |
| D0340 |
|
1,119 |
1,114 |
$56K |
| D9430 |
|
1,436 |
1,241 |
$46K |
| D1120 |
Prophylaxis - child |
816 |
808 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
838 |
833 |
$40K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
695 |
371 |
$38K |
| D1110 |
Prophylaxis - adult |
403 |
399 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
395 |
389 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,893 |
1,624 |
$28K |
| D0330 |
Panoramic radiographic image |
877 |
873 |
$26K |
| D1351 |
Sealant - per tooth |
663 |
173 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,502 |
1,490 |
$22K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
42 |
29 |
$20K |
| D1320 |
|
1,176 |
1,168 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
138 |
79 |
$11K |
| D0274 |
Bitewings - four radiographic images |
427 |
426 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
720 |
636 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
153 |
152 |
$5K |
| D8670 |
Periodic orthodontic treatment visit |
12 |
12 |
$4K |
| D4910 |
|
27 |
27 |
$2K |
| D2954 |
|
18 |
14 |
$2K |
| D2330 |
|
22 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
25 |
25 |
$300.00 |