| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1352 |
|
5,680 |
1,099 |
$367K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,966 |
1,571 |
$339K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,313 |
1,574 |
$322K |
| D4355 |
|
2,847 |
2,839 |
$212K |
| D0120 |
Periodic oral evaluation - established patient |
5,719 |
5,702 |
$132K |
| D2740 |
Crown - porcelain/ceramic |
191 |
120 |
$121K |
| D0210 |
Intraoral - complete series of radiographic images |
1,669 |
1,652 |
$94K |
| D1110 |
Prophylaxis - adult |
1,934 |
1,932 |
$83K |
| D0274 |
Bitewings - four radiographic images |
2,520 |
2,510 |
$69K |
| D1120 |
Prophylaxis - child |
1,584 |
1,578 |
$62K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,325 |
2,315 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
1,730 |
1,658 |
$52K |
| D2950 |
|
302 |
194 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,658 |
3,579 |
$46K |
| D4341 |
|
317 |
103 |
$43K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
528 |
255 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,965 |
2,698 |
$33K |
| D1351 |
Sealant - per tooth |
715 |
102 |
$22K |
| D2394 |
|
114 |
90 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
297 |
297 |
$9K |
| D0272 |
Bitewings - two radiographic images |
132 |
132 |
$3K |
| D4910 |
|
25 |
25 |
$2K |