| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
4,051 |
1,039 |
$675K |
| D2750 |
|
306 |
194 |
$134K |
| D3120 |
|
3,162 |
967 |
$109K |
| D1110 |
Prophylaxis - adult |
1,558 |
1,547 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,543 |
1,520 |
$83K |
| D1206 |
Topical application of fluoride varnish |
2,889 |
2,857 |
$73K |
| D1351 |
Sealant - per tooth |
1,330 |
216 |
$46K |
| D0120 |
Periodic oral evaluation - established patient |
1,365 |
1,352 |
$43K |
| D1120 |
Prophylaxis - child |
914 |
894 |
$40K |
| D2335 |
|
251 |
112 |
$40K |
| D0220 |
Intraoral - periapical first radiographic image |
3,003 |
2,812 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
572 |
557 |
$32K |
| D4341 |
|
378 |
118 |
$31K |
| D2740 |
Crown - porcelain/ceramic |
71 |
39 |
$27K |
| D0274 |
Bitewings - four radiographic images |
1,118 |
1,113 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,277 |
2,219 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
517 |
488 |
$24K |
| D2950 |
|
288 |
183 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
62 |
$17K |
| D0330 |
Panoramic radiographic image |
326 |
323 |
$15K |
| D7140 |
Extraction, erupted tooth or exposed root |
96 |
34 |
$13K |
| D0460 |
|
507 |
461 |
$5K |
| D1330 |
|
761 |
750 |
$5K |
| D2332 |
|
32 |
13 |
$5K |
| D9910 |
|
376 |
318 |
$4K |
| D4355 |
|
30 |
30 |
$3K |
| D0272 |
Bitewings - two radiographic images |
184 |
176 |
$3K |