| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,584 |
1,435 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
4,327 |
4,302 |
$67K |
| D1110 |
Prophylaxis - adult |
4,103 |
4,074 |
$65K |
| D0210 |
Intraoral - complete series of radiographic images |
1,852 |
1,848 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,195 |
904 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,256 |
1,241 |
$28K |
| D1120 |
Prophylaxis - child |
1,806 |
1,794 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,047 |
2,032 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
1,307 |
1,271 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
54 |
40 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
11,320 |
2,516 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
3,523 |
3,377 |
$9K |
| D0330 |
Panoramic radiographic image |
848 |
838 |
$7K |
| D0274 |
Bitewings - four radiographic images |
1,734 |
1,720 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
99 |
81 |
$4K |
| D2950 |
|
16 |
13 |
$720.00 |
| D2331 |
|
14 |
12 |
$595.00 |
| D4355 |
|
12 |
12 |
$495.00 |