| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
2,085 |
2,074 |
$173K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,040 |
2,026 |
$125K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,830 |
1,097 |
$119K |
| D0120 |
Periodic oral evaluation - established patient |
1,640 |
1,637 |
$101K |
| D0210 |
Intraoral - complete series of radiographic images |
1,902 |
1,888 |
$88K |
| D2740 |
Crown - porcelain/ceramic |
174 |
111 |
$77K |
| D9430 |
|
2,374 |
2,145 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
935 |
552 |
$49K |
| D0350 |
|
3,939 |
1,925 |
$42K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,123 |
3,110 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,410 |
1,408 |
$30K |
| D1120 |
Prophylaxis - child |
770 |
770 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,464 |
1,646 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
1,462 |
1,380 |
$17K |
| D4910 |
|
148 |
148 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
123 |
75 |
$10K |
| D2330 |
|
30 |
12 |
$2K |