| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,949 |
1,356 |
$228K |
| D2335 |
|
1,655 |
853 |
$193K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
2,473 |
1,152 |
$163K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,780 |
926 |
$160K |
| D2332 |
|
1,607 |
819 |
$146K |
| D2140 |
|
2,453 |
1,055 |
$128K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,363 |
806 |
$104K |
| D2160 |
|
1,190 |
708 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,711 |
1,634 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,208 |
2,155 |
$62K |
| D1110 |
Prophylaxis - adult |
1,809 |
1,730 |
$54K |
| D0274 |
Bitewings - four radiographic images |
1,845 |
1,789 |
$52K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,729 |
2,650 |
$51K |
| D2330 |
|
781 |
430 |
$43K |
| D1120 |
Prophylaxis - child |
907 |
883 |
$38K |
| D2394 |
|
322 |
216 |
$37K |
| D0330 |
Panoramic radiographic image |
2,322 |
2,230 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,174 |
1,161 |
$32K |
| D2331 |
|
439 |
271 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
2,232 |
2,172 |
$26K |
| D1351 |
Sealant - per tooth |
320 |
84 |
$10K |
| D0272 |
Bitewings - two radiographic images |
378 |
373 |
$9K |
| D2161 |
|
36 |
29 |
$4K |