| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,812 |
1,043 |
$112K |
| D0350 |
|
10,196 |
3,594 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,266 |
1,262 |
$81K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
985 |
693 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
873 |
871 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
979 |
974 |
$45K |
| D1120 |
Prophylaxis - child |
978 |
975 |
$45K |
| D1110 |
Prophylaxis - adult |
336 |
336 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
506 |
308 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,599 |
1,595 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,110 |
1,108 |
$22K |
| D9430 |
|
595 |
540 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,042 |
1,627 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
13 |
12 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
208 |
208 |
$2K |
| D2394 |
|
27 |
25 |
$2K |
| D0270 |
|
27 |
27 |
$135.00 |