| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,719 |
2,698 |
$159K |
| D2740 |
Crown - porcelain/ceramic |
320 |
277 |
$152K |
| D4910 |
|
1,598 |
1,593 |
$123K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,431 |
1,169 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,482 |
1,479 |
$88K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
785 |
715 |
$62K |
| D0274 |
Bitewings - four radiographic images |
2,454 |
2,431 |
$51K |
| D9430 |
|
1,572 |
1,549 |
$50K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,520 |
3,591 |
$49K |
| D0210 |
Intraoral - complete series of radiographic images |
927 |
926 |
$43K |
| D1120 |
Prophylaxis - child |
1,151 |
1,136 |
$40K |
| D4341 |
|
571 |
162 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
2,220 |
2,186 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,594 |
1,580 |
$18K |
| D4342 |
|
211 |
79 |
$9K |
| D2332 |
|
44 |
24 |
$4K |
| D0350 |
|
199 |
143 |
$2K |
| D1110 |
Prophylaxis - adult |
32 |
32 |
$2K |
| D2931 |
|
13 |
12 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$873.60 |
| D0272 |
Bitewings - two radiographic images |
63 |
62 |
$639.50 |
| D1320 |
|
30 |
30 |
$492.50 |
| D1206 |
Topical application of fluoride varnish |
18 |
18 |
$174.00 |