| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,504 |
1,751 |
$264K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,862 |
1,500 |
$192K |
| D2740 |
Crown - porcelain/ceramic |
241 |
175 |
$190K |
| D1110 |
Prophylaxis - adult |
3,511 |
3,400 |
$147K |
| D0330 |
Panoramic radiographic image |
2,327 |
2,262 |
$118K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,288 |
824 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,516 |
2,455 |
$74K |
| D0240 |
|
5,440 |
2,321 |
$70K |
| D0274 |
Bitewings - four radiographic images |
2,452 |
2,363 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,806 |
1,730 |
$47K |
| D0120 |
Periodic oral evaluation - established patient |
2,097 |
2,015 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,138 |
2,087 |
$38K |
| D1120 |
Prophylaxis - child |
1,346 |
1,327 |
$31K |
| D2332 |
|
246 |
113 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
239 |
233 |
$27K |
| D2954 |
|
98 |
65 |
$25K |
| D9944 |
|
46 |
45 |
$12K |
| D2950 |
|
68 |
51 |
$9K |
| D0272 |
Bitewings - two radiographic images |
671 |
662 |
$7K |
| D2330 |
|
126 |
66 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
1,082 |
1,038 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
773 |
353 |
$3K |
| D2331 |
|
37 |
14 |
$2K |