| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
6,050 |
6,044 |
$291K |
| D2750 |
|
458 |
272 |
$250K |
| D2740 |
Crown - porcelain/ceramic |
477 |
289 |
$242K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,593 |
1,744 |
$193K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,812 |
1,257 |
$168K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,895 |
1,630 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
4,323 |
4,320 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,120 |
3,120 |
$93K |
| D0274 |
Bitewings - four radiographic images |
3,213 |
3,207 |
$81K |
| D0210 |
Intraoral - complete series of radiographic images |
1,517 |
1,513 |
$64K |
| D4341 |
|
1,246 |
580 |
$63K |
| D2331 |
|
790 |
573 |
$63K |
| D2330 |
|
845 |
579 |
$49K |
| D2332 |
|
443 |
302 |
$42K |
| D3310 |
|
153 |
66 |
$37K |
| D0330 |
Panoramic radiographic image |
835 |
835 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
1,362 |
1,357 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,499 |
1,484 |
$15K |
| D3320 |
|
47 |
39 |
$14K |
| D2394 |
|
63 |
53 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
390 |
389 |
$3K |
| D9944 |
|
13 |
13 |
$2K |
| D2335 |
|
13 |
12 |
$2K |
| D9110 |
|
14 |
14 |
$361.30 |