| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9999 |
Unspecified adjunctive procedure, by report |
10,260 |
8,899 |
$226K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,639 |
2,160 |
$176K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
3,166 |
2,131 |
$171K |
| D4341 |
|
2,167 |
1,090 |
$149K |
| D4342 |
|
2,187 |
1,126 |
$90K |
| D4910 |
|
1,105 |
1,094 |
$79K |
| D1206 |
Topical application of fluoride varnish |
3,797 |
3,755 |
$63K |
| D2330 |
|
709 |
468 |
$54K |
| D2331 |
|
634 |
507 |
$53K |
| D1110 |
Prophylaxis - adult |
543 |
543 |
$48K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
498 |
447 |
$39K |
| D2332 |
|
196 |
157 |
$18K |
| D5110 |
|
28 |
27 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
30 |
26 |
$14K |
| D5120 |
|
12 |
12 |
$8K |
| D1120 |
Prophylaxis - child |
194 |
194 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
51 |
50 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
37 |
37 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
30 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
13 |
12 |
$873.60 |
| D0274 |
Bitewings - four radiographic images |
33 |
33 |
$626.40 |