| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,745 |
1,165 |
$155K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,939 |
1,134 |
$128K |
| D1110 |
Prophylaxis - adult |
2,346 |
2,339 |
$96K |
| D0120 |
Periodic oral evaluation - established patient |
2,548 |
2,546 |
$59K |
| D0210 |
Intraoral - complete series of radiographic images |
1,006 |
1,004 |
$52K |
| D2740 |
Crown - porcelain/ceramic |
96 |
63 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,457 |
1,451 |
$47K |
| D0274 |
Bitewings - four radiographic images |
1,484 |
1,475 |
$39K |
| D0220 |
Intraoral - periapical first radiographic image |
2,385 |
2,356 |
$31K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
310 |
250 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,090 |
2,066 |
$25K |
| D1120 |
Prophylaxis - child |
612 |
611 |
$25K |
| D2950 |
|
183 |
152 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
418 |
417 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
566 |
566 |
$13K |
| D4341 |
|
80 |
26 |
$11K |
| D1206 |
Topical application of fluoride varnish |
155 |
154 |
$2K |
| D2330 |
|
24 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
63 |
63 |
$1K |