| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9910 |
|
2,007 |
831 |
$121K |
| D1110 |
Prophylaxis - adult |
1,165 |
1,154 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,506 |
1,498 |
$99K |
| D4910 |
|
967 |
953 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
1,086 |
1,071 |
$72K |
| D0210 |
Intraoral - complete series of radiographic images |
1,064 |
1,058 |
$50K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
609 |
340 |
$41K |
| D1120 |
Prophylaxis - child |
602 |
597 |
$27K |
| D9430 |
|
793 |
770 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,698 |
1,679 |
$23K |
| D0274 |
Bitewings - four radiographic images |
822 |
813 |
$17K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
132 |
77 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
276 |
139 |
$15K |
| D4341 |
|
185 |
58 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,045 |
1,291 |
$13K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
22 |
15 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
690 |
672 |
$8K |
| D1206 |
Topical application of fluoride varnish |
202 |
202 |
$3K |
| D0350 |
|
225 |
106 |
$2K |
| D1320 |
|
117 |
117 |
$2K |