| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
12,337 |
3,949 |
$783K |
| D1110 |
Prophylaxis - adult |
8,453 |
8,292 |
$473K |
| D2332 |
|
3,578 |
1,199 |
$383K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,100 |
1,940 |
$339K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,822 |
1,289 |
$273K |
| D0120 |
Periodic oral evaluation - established patient |
10,159 |
9,988 |
$250K |
| D2330 |
|
2,468 |
1,038 |
$176K |
| D0274 |
Bitewings - four radiographic images |
4,650 |
4,546 |
$171K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,475 |
5,431 |
$158K |
| D1120 |
Prophylaxis - child |
2,926 |
2,905 |
$149K |
| D0220 |
Intraoral - periapical first radiographic image |
7,087 |
6,931 |
$117K |
| D1351 |
Sealant - per tooth |
2,497 |
606 |
$97K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,655 |
5,977 |
$91K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,461 |
1,449 |
$65K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
78 |
51 |
$48K |
| D9110 |
|
632 |
610 |
$27K |
| D0272 |
Bitewings - two radiographic images |
670 |
667 |
$19K |
| D2331 |
|
182 |
84 |
$16K |
| D0210 |
Intraoral - complete series of radiographic images |
159 |
154 |
$11K |
| D2140 |
|
117 |
45 |
$9K |
| D7111 |
|
113 |
68 |
$9K |
| D2335 |
|
26 |
12 |
$4K |
| D2394 |
|
19 |
12 |
$2K |