| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,538 |
1,380 |
$308K |
| D0120 |
Periodic oral evaluation - established patient |
6,781 |
6,355 |
$149K |
| D1110 |
Prophylaxis - adult |
2,816 |
2,582 |
$128K |
| D1120 |
Prophylaxis - child |
3,183 |
3,047 |
$105K |
| D0274 |
Bitewings - four radiographic images |
3,317 |
3,108 |
$101K |
| D0367 |
|
339 |
302 |
$88K |
| D1206 |
Topical application of fluoride varnish |
4,691 |
4,458 |
$87K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
563 |
355 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
845 |
776 |
$27K |
| D2950 |
|
197 |
153 |
$25K |
| D2740 |
Crown - porcelain/ceramic |
37 |
31 |
$24K |
| D0140 |
Limited oral evaluation - problem focused |
801 |
697 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,128 |
1,090 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
71 |
40 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
560 |
513 |
$8K |
| D0330 |
Panoramic radiographic image |
104 |
103 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
62 |
60 |
$4K |
| D4355 |
|
26 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
56 |
13 |
$1K |
| D3120 |
|
14 |
12 |
$434.09 |
| D2999 |
|
14 |
12 |
$0.00 |