| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,823 |
332 |
$99K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
67 |
43 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
480 |
475 |
$31K |
| D1110 |
Prophylaxis - adult |
285 |
279 |
$23K |
| D2330 |
|
209 |
71 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
201 |
99 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
272 |
268 |
$13K |
| D0350 |
|
305 |
302 |
$8K |
| D2954 |
|
60 |
41 |
$6K |
| D9430 |
|
152 |
133 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
309 |
304 |
$4K |
| D4341 |
|
49 |
14 |
$3K |
| D1320 |
|
191 |
190 |
$3K |
| D0330 |
Panoramic radiographic image |
98 |
96 |
$3K |
| D0274 |
Bitewings - four radiographic images |
32 |
32 |
$691.20 |
| D0230 |
Intraoral - periapical each additional radiographic image |
55 |
29 |
$510.30 |