| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
2,579 |
1,295 |
$508K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,813 |
994 |
$299K |
| D2740 |
Crown - porcelain/ceramic |
346 |
234 |
$175K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
888 |
450 |
$121K |
| D4342 |
|
864 |
231 |
$79K |
| D4910 |
|
708 |
703 |
$51K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,023 |
1,023 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,332 |
1,329 |
$31K |
| D1110 |
Prophylaxis - adult |
729 |
728 |
$30K |
| D0210 |
Intraoral - complete series of radiographic images |
552 |
552 |
$29K |
| D2950 |
|
232 |
154 |
$29K |
| D0274 |
Bitewings - four radiographic images |
659 |
656 |
$19K |
| D2335 |
|
92 |
42 |
$16K |
| D2332 |
|
104 |
68 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
380 |
376 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
906 |
898 |
$11K |
| D0350 |
|
272 |
270 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
180 |
180 |
$6K |
| D1206 |
Topical application of fluoride varnish |
312 |
309 |
$5K |
| D1120 |
Prophylaxis - child |
51 |
51 |
$2K |
| D0460 |
|
67 |
65 |
$2K |