| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
938 |
537 |
$77K |
| D1110 |
Prophylaxis - adult |
1,452 |
1,414 |
$52K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
486 |
259 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,385 |
1,221 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
191 |
109 |
$25K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,535 |
1,251 |
$19K |
| D0210 |
Intraoral - complete series of radiographic images |
542 |
496 |
$18K |
| D0274 |
Bitewings - four radiographic images |
928 |
897 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
1,322 |
1,309 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,099 |
1,745 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
702 |
686 |
$12K |
| D2950 |
|
57 |
37 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
393 |
376 |
$6K |
| D9994 |
|
1,477 |
1,458 |
$6K |
| D3120 |
|
327 |
149 |
$2K |
| D1120 |
Prophylaxis - child |
71 |
71 |
$1K |
| D0330 |
Panoramic radiographic image |
23 |
13 |
$539.90 |
| D4910 |
|
168 |
167 |
$80.72 |
| D2740 |
Crown - porcelain/ceramic |
30 |
14 |
$0.00 |
| D0270 |
|
13 |
12 |
$0.00 |
| D4341 |
|
248 |
81 |
$0.00 |
| D9630 |
|
365 |
365 |
$0.00 |