| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,292 |
409 |
$32K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,236 |
1,008 |
$20K |
| D0210 |
Intraoral - complete series of radiographic images |
717 |
602 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
1,154 |
906 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
264 |
107 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,254 |
637 |
$4K |
| D2750 |
|
21 |
12 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
1,161 |
868 |
$3K |
| D0274 |
Bitewings - four radiographic images |
492 |
341 |
$3K |
| D2952 |
|
33 |
28 |
$2K |
| D1120 |
Prophylaxis - child |
130 |
93 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
165 |
117 |
$1K |
| D1110 |
Prophylaxis - adult |
129 |
114 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
12 |
$1K |