| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,916 |
519 |
$133K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,405 |
373 |
$111K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,475 |
1,473 |
$97K |
| D4910 |
|
1,278 |
1,264 |
$95K |
| D1110 |
Prophylaxis - adult |
1,050 |
1,046 |
$88K |
| D9430 |
|
2,477 |
2,046 |
$77K |
| D2160 |
|
794 |
297 |
$63K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,951 |
2,306 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
500 |
495 |
$41K |
| D2740 |
Crown - porcelain/ceramic |
80 |
53 |
$38K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
534 |
233 |
$35K |
| D0274 |
Bitewings - four radiographic images |
1,644 |
1,640 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
547 |
174 |
$30K |
| D0350 |
|
4,081 |
706 |
$29K |
| D1120 |
Prophylaxis - child |
566 |
564 |
$29K |
| D0330 |
Panoramic radiographic image |
936 |
935 |
$28K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
419 |
204 |
$28K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,700 |
1,680 |
$26K |
| D1320 |
|
2,050 |
2,044 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,711 |
1,355 |
$20K |
| D2161 |
|
125 |
55 |
$10K |
| D4342 |
|
229 |
74 |
$10K |
| D1351 |
Sealant - per tooth |
269 |
45 |
$10K |
| D2394 |
|
112 |
65 |
$9K |
| D2140 |
|
162 |
47 |
$9K |
| D2954 |
|
55 |
38 |
$6K |
| D2330 |
|
46 |
26 |
$4K |
| D1310 |
|
195 |
194 |
$3K |
| D0602 |
|
481 |
480 |
$1K |
| D0272 |
Bitewings - two radiographic images |
68 |
68 |
$813.00 |
| D1330 |
|
401 |
398 |
$0.00 |
| D9110 |
|
15 |
13 |
$0.00 |