| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,233 |
934 |
$81K |
| D4910 |
|
1,008 |
1,004 |
$77K |
| D0120 |
Periodic oral evaluation - established patient |
945 |
942 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,106 |
1,099 |
$72K |
| D0350 |
|
7,298 |
2,350 |
$71K |
| D4341 |
|
869 |
252 |
$61K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
94 |
71 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
935 |
928 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
764 |
519 |
$41K |
| D1110 |
Prophylaxis - adult |
340 |
336 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,534 |
1,610 |
$30K |
| D0274 |
Bitewings - four radiographic images |
920 |
916 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
149 |
121 |
$12K |
| D9430 |
|
362 |
352 |
$12K |
| D1120 |
Prophylaxis - child |
239 |
239 |
$11K |
| D2330 |
|
56 |
38 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
213 |
213 |
$3K |
| D1206 |
Topical application of fluoride varnish |
140 |
140 |
$2K |