| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,355 |
1,230 |
$189K |
| D1110 |
Prophylaxis - adult |
3,373 |
3,306 |
$140K |
| D2394 |
|
1,503 |
789 |
$126K |
| D0120 |
Periodic oral evaluation - established patient |
5,180 |
5,079 |
$123K |
| D1120 |
Prophylaxis - child |
3,108 |
3,034 |
$100K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,365 |
926 |
$98K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,562 |
4,457 |
$92K |
| D0210 |
Intraoral - complete series of radiographic images |
1,027 |
1,002 |
$56K |
| D0274 |
Bitewings - four radiographic images |
1,927 |
1,891 |
$49K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,259 |
1,223 |
$35K |
| D1206 |
Topical application of fluoride varnish |
1,130 |
1,115 |
$23K |
| D2740 |
Crown - porcelain/ceramic |
46 |
25 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
473 |
456 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
69 |
$6K |
| D0330 |
Panoramic radiographic image |
123 |
121 |
$4K |
| D0272 |
Bitewings - two radiographic images |
224 |
219 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
305 |
293 |
$4K |
| D1351 |
Sealant - per tooth |
70 |
19 |
$2K |
| D1330 |
|
45 |
36 |
$0.00 |