| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,491 |
1,484 |
$59K |
| D9920 |
|
572 |
522 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
679 |
462 |
$33K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
345 |
240 |
$27K |
| D0330 |
Panoramic radiographic image |
260 |
259 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
873 |
870 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
504 |
313 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
195 |
195 |
$12K |
| D2335 |
|
61 |
36 |
$6K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
639 |
634 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,290 |
1,175 |
$4K |
| D0274 |
Bitewings - four radiographic images |
1,036 |
1,030 |
$3K |
| D4341 |
|
84 |
41 |
$3K |
| D2332 |
|
59 |
38 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
1,270 |
1,257 |
$2K |
| D1206 |
Topical application of fluoride varnish |
466 |
462 |
$1K |
| D1330 |
|
1,179 |
1,176 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
18 |
14 |
$412.30 |
| D0431 |
|
39 |
39 |
$0.00 |