| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,689 |
522 |
$142K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,141 |
789 |
$115K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,126 |
500 |
$77K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,108 |
1,083 |
$39K |
| D1110 |
Prophylaxis - adult |
622 |
609 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
375 |
365 |
$19K |
| D4910 |
|
311 |
301 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
677 |
659 |
$16K |
| D2330 |
|
257 |
165 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
1,062 |
948 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
364 |
343 |
$12K |
| D0274 |
Bitewings - four radiographic images |
442 |
438 |
$12K |
| D1206 |
Topical application of fluoride varnish |
682 |
656 |
$12K |
| D2335 |
|
96 |
61 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
109 |
73 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
888 |
607 |
$7K |
| D4342 |
|
114 |
93 |
$7K |
| D1120 |
Prophylaxis - child |
88 |
88 |
$4K |
| D2331 |
|
47 |
37 |
$3K |
| D2332 |
|
15 |
13 |
$1K |