| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2331 |
|
7,149 |
3,592 |
$458K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
6,789 |
3,054 |
$334K |
| D1110 |
Prophylaxis - adult |
3,589 |
3,575 |
$156K |
| D1120 |
Prophylaxis - child |
3,019 |
3,014 |
$135K |
| D2330 |
|
2,646 |
1,631 |
$131K |
| D0120 |
Periodic oral evaluation - established patient |
5,001 |
4,981 |
$125K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,255 |
1,080 |
$112K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,988 |
1,128 |
$94K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,199 |
3,195 |
$73K |
| D0140 |
Limited oral evaluation - problem focused |
974 |
937 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,550 |
1,547 |
$39K |
| D0274 |
Bitewings - four radiographic images |
2,702 |
2,699 |
$32K |
| D1351 |
Sealant - per tooth |
1,126 |
184 |
$23K |
| D0210 |
Intraoral - complete series of radiographic images |
448 |
446 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
3,485 |
3,460 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,216 |
3,195 |
$10K |