| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,728 |
965 |
$210K |
| D1110 |
Prophylaxis - adult |
2,532 |
2,421 |
$122K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,086 |
589 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,053 |
1,946 |
$66K |
| D0330 |
Panoramic radiographic image |
1,104 |
1,038 |
$55K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,367 |
1,284 |
$44K |
| D2740 |
Crown - porcelain/ceramic |
71 |
60 |
$41K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
84 |
69 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,309 |
2,135 |
$34K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
208 |
150 |
$34K |
| D0120 |
Periodic oral evaluation - established patient |
1,329 |
1,274 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
1,036 |
951 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,507 |
1,429 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,610 |
1,539 |
$13K |
| D1206 |
Topical application of fluoride varnish |
461 |
453 |
$9K |
| D1120 |
Prophylaxis - child |
143 |
138 |
$6K |
| D2950 |
|
39 |
37 |
$5K |
| D1351 |
Sealant - per tooth |
149 |
30 |
$4K |
| D2331 |
|
19 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
15 |
12 |
$279.20 |