| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,231 |
1,032 |
$157K |
| D1110 |
Prophylaxis - adult |
1,963 |
1,923 |
$134K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,835 |
912 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,017 |
1,001 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
1,856 |
1,810 |
$47K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
78 |
54 |
$35K |
| D0274 |
Bitewings - four radiographic images |
2,102 |
2,070 |
$34K |
| D2332 |
|
554 |
223 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,355 |
2,335 |
$15K |
| D2335 |
|
84 |
26 |
$8K |
| D2952 |
|
72 |
52 |
$6K |
| D2394 |
|
73 |
55 |
$6K |
| D1120 |
Prophylaxis - child |
135 |
132 |
$3K |
| D4341 |
|
47 |
13 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
508 |
473 |
$3K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
12 |
$2K |
| D2920 |
|
33 |
24 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
98 |
96 |
$1K |
| D1999 |
|
145 |
131 |
$176.00 |
| D9430 |
|
53 |
41 |
$28.00 |
| D0140 |
Limited oral evaluation - problem focused |
31 |
31 |
$0.00 |