| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2394 |
|
2,009 |
1,016 |
$172K |
| D0330 |
Panoramic radiographic image |
2,703 |
2,541 |
$151K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,080 |
991 |
$126K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,550 |
753 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,888 |
2,729 |
$90K |
| D1110 |
Prophylaxis - adult |
2,081 |
1,988 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
4,037 |
3,811 |
$75K |
| D0274 |
Bitewings - four radiographic images |
2,994 |
2,822 |
$68K |
| D2335 |
|
420 |
139 |
$49K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
784 |
313 |
$47K |
| D2740 |
Crown - porcelain/ceramic |
57 |
29 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,299 |
1,184 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
3,201 |
2,910 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,296 |
984 |
$16K |
| D1206 |
Topical application of fluoride varnish |
989 |
949 |
$16K |
| D2161 |
|
166 |
80 |
$14K |
| D2332 |
|
101 |
28 |
$9K |
| D2160 |
|
114 |
64 |
$8K |
| D1120 |
Prophylaxis - child |
352 |
337 |
$7K |
| D2950 |
|
51 |
27 |
$7K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
111 |
68 |
$7K |
| D2140 |
|
63 |
28 |
$3K |
| D1351 |
Sealant - per tooth |
57 |
13 |
$1K |
| D0272 |
Bitewings - two radiographic images |
80 |
76 |
$847.30 |