| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2330 |
|
6,871 |
2,970 |
$535K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,051 |
1,596 |
$320K |
| D4910 |
|
2,380 |
2,375 |
$181K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,017 |
1,435 |
$163K |
| D0120 |
Periodic oral evaluation - established patient |
3,722 |
3,709 |
$116K |
| D0230 |
Intraoral - periapical each additional radiographic image |
25,064 |
5,233 |
$76K |
| D1120 |
Prophylaxis - child |
1,137 |
1,132 |
$45K |
| D0274 |
Bitewings - four radiographic images |
3,240 |
3,229 |
$40K |
| D2394 |
|
432 |
246 |
$36K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,459 |
4,427 |
$34K |
| D2740 |
Crown - porcelain/ceramic |
64 |
42 |
$30K |
| D2161 |
|
344 |
168 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
476 |
470 |
$28K |
| D9430 |
|
718 |
576 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
2,339 |
1,892 |
$23K |
| D1110 |
Prophylaxis - adult |
228 |
227 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
351 |
345 |
$16K |
| D2160 |
|
182 |
93 |
$15K |
| D2954 |
|
64 |
42 |
$7K |
| D0350 |
|
566 |
255 |
$6K |
| D4341 |
|
49 |
13 |
$3K |
| D1351 |
Sealant - per tooth |
95 |
25 |
$2K |
| D0272 |
Bitewings - two radiographic images |
176 |
176 |
$2K |