| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,606 |
1,106 |
$190K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
862 |
567 |
$83K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,124 |
572 |
$82K |
| D1110 |
Prophylaxis - adult |
2,406 |
2,386 |
$81K |
| D0330 |
Panoramic radiographic image |
1,160 |
1,112 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,294 |
1,220 |
$31K |
| D0274 |
Bitewings - four radiographic images |
1,303 |
1,288 |
$25K |
| D2740 |
Crown - porcelain/ceramic |
73 |
58 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,359 |
1,346 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
795 |
745 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
990 |
921 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
343 |
341 |
$5K |
| D9920 |
|
78 |
75 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
51 |
$4K |
| D9110 |
|
16 |
16 |
$1K |
| D2950 |
|
46 |
42 |
$0.00 |
| D1120 |
Prophylaxis - child |
14 |
14 |
$0.00 |