| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
3,537 |
3,508 |
$182K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,759 |
1,726 |
$160K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,216 |
1,738 |
$149K |
| D0120 |
Periodic oral evaluation - established patient |
3,886 |
3,852 |
$114K |
| D0140 |
Limited oral evaluation - problem focused |
2,220 |
2,168 |
$113K |
| D1120 |
Prophylaxis - child |
1,290 |
1,283 |
$68K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
734 |
537 |
$51K |
| D2331 |
|
691 |
407 |
$50K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
80 |
66 |
$46K |
| D2330 |
|
671 |
422 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,740 |
1,724 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
778 |
772 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
317 |
317 |
$17K |
| D2332 |
|
160 |
104 |
$13K |
| D2335 |
|
137 |
91 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,381 |
1,339 |
$8K |
| D0330 |
Panoramic radiographic image |
240 |
235 |
$7K |
| D2952 |
|
34 |
24 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
180 |
180 |
$5K |
| D1206 |
Topical application of fluoride varnish |
103 |
100 |
$4K |
| D0191 |
|
127 |
127 |
$991.00 |
| D0272 |
Bitewings - two radiographic images |
81 |
81 |
$972.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
240 |
122 |
$493.20 |