| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,087 |
2,077 |
$132K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,948 |
955 |
$129K |
| D1110 |
Prophylaxis - adult |
1,157 |
1,151 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
1,664 |
1,653 |
$93K |
| D0210 |
Intraoral - complete series of radiographic images |
2,092 |
2,080 |
$93K |
| D1120 |
Prophylaxis - child |
1,347 |
1,340 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
556 |
316 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
384 |
255 |
$30K |
| D0274 |
Bitewings - four radiographic images |
1,191 |
1,182 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,566 |
1,858 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
30 |
25 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
174 |
104 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
728 |
724 |
$9K |
| D9430 |
|
260 |
258 |
$8K |
| D4341 |
|
52 |
14 |
$4K |
| D2140 |
|
60 |
40 |
$3K |
| D1351 |
Sealant - per tooth |
44 |
12 |
$2K |