| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,213 |
2,941 |
$684K |
| D2740 |
Crown - porcelain/ceramic |
962 |
771 |
$480K |
| D1110 |
Prophylaxis - adult |
6,311 |
6,282 |
$278K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,326 |
4,312 |
$172K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
989 |
677 |
$154K |
| D0120 |
Periodic oral evaluation - established patient |
6,550 |
6,518 |
$151K |
| D0140 |
Limited oral evaluation - problem focused |
4,222 |
4,163 |
$143K |
| D0220 |
Intraoral - periapical first radiographic image |
10,468 |
10,330 |
$129K |
| D0274 |
Bitewings - four radiographic images |
4,278 |
4,267 |
$128K |
| D0210 |
Intraoral - complete series of radiographic images |
2,002 |
1,986 |
$120K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,231 |
5,208 |
$88K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
759 |
515 |
$78K |
| D2950 |
|
482 |
403 |
$60K |
| D4342 |
|
504 |
221 |
$45K |
| D0350 |
|
895 |
662 |
$35K |
| D1206 |
Topical application of fluoride varnish |
916 |
912 |
$17K |
| D4910 |
|
243 |
236 |
$16K |
| D0330 |
Panoramic radiographic image |
246 |
246 |
$12K |
| D2332 |
|
34 |
26 |
$5K |
| D0270 |
|
347 |
345 |
$4K |
| D1120 |
Prophylaxis - child |
76 |
76 |
$2K |
| D2330 |
|
15 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$242.64 |