| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
1,108 |
493 |
$221K |
| D2740 |
Crown - porcelain/ceramic |
251 |
118 |
$206K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
961 |
435 |
$160K |
| D4341 |
|
476 |
141 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
344 |
157 |
$47K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
785 |
763 |
$34K |
| D0210 |
Intraoral - complete series of radiographic images |
484 |
480 |
$26K |
| D4910 |
|
324 |
322 |
$26K |
| D2950 |
|
165 |
78 |
$22K |
| D4342 |
|
227 |
61 |
$21K |
| D0350 |
|
520 |
518 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
268 |
267 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
369 |
369 |
$10K |
| D1206 |
Topical application of fluoride varnish |
265 |
251 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
425 |
413 |
$5K |
| D0274 |
Bitewings - four radiographic images |
143 |
133 |
$4K |
| D2954 |
|
17 |
13 |
$3K |
| D1110 |
Prophylaxis - adult |
36 |
36 |
$2K |
| D0460 |
|
77 |
77 |
$2K |
| D1120 |
Prophylaxis - child |
40 |
28 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
18 |
18 |
$583.10 |