| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,236 |
3,190 |
$340K |
| D1110 |
Prophylaxis - adult |
6,954 |
6,938 |
$305K |
| D0120 |
Periodic oral evaluation - established patient |
8,001 |
7,980 |
$177K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,853 |
1,569 |
$158K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
172 |
163 |
$80K |
| D0220 |
Intraoral - periapical first radiographic image |
7,435 |
7,388 |
$79K |
| D0274 |
Bitewings - four radiographic images |
3,534 |
3,534 |
$77K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,007 |
5,993 |
$61K |
| D1120 |
Prophylaxis - child |
1,527 |
1,522 |
$50K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
919 |
791 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
1,181 |
1,179 |
$37K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
496 |
472 |
$37K |
| D2331 |
|
394 |
361 |
$34K |
| D0272 |
Bitewings - two radiographic images |
1,729 |
1,727 |
$22K |
| D9310 |
|
303 |
303 |
$18K |
| D2954 |
|
152 |
151 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,555 |
1,551 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
544 |
544 |
$12K |
| D1206 |
Topical application of fluoride varnish |
533 |
532 |
$12K |
| D0270 |
|
1,033 |
1,029 |
$11K |
| D9110 |
|
451 |
450 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
142 |
141 |
$1K |