| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,529 |
1,499 |
$54K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
735 |
382 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,018 |
999 |
$45K |
| D2740 |
Crown - porcelain/ceramic |
108 |
98 |
$42K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,472 |
1,446 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,176 |
2,135 |
$32K |
| D4341 |
|
301 |
94 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
409 |
199 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
980 |
966 |
$16K |
| D1120 |
Prophylaxis - child |
406 |
398 |
$10K |
| D0274 |
Bitewings - four radiographic images |
547 |
540 |
$10K |
| D2332 |
|
129 |
58 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
82 |
$9K |
| D2950 |
|
89 |
79 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
234 |
226 |
$6K |
| D4910 |
|
73 |
73 |
$4K |
| D1351 |
Sealant - per tooth |
146 |
30 |
$4K |
| D2330 |
|
56 |
28 |
$3K |
| D0603 |
|
476 |
472 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
222 |
219 |
$2K |
| D0601 |
|
537 |
528 |
$2K |
| D0602 |
|
443 |
440 |
$2K |
| D0330 |
Panoramic radiographic image |
199 |
197 |
$2K |