| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
578 |
459 |
$17K |
| D0350 |
|
453 |
363 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
185 |
185 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
207 |
205 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,160 |
534 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
134 |
134 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
74 |
36 |
$6K |
| D1206 |
Topical application of fluoride varnish |
425 |
417 |
$6K |
| D4910 |
|
66 |
65 |
$5K |
| D1110 |
Prophylaxis - adult |
49 |
49 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
15 |
$2K |
| D0274 |
Bitewings - four radiographic images |
122 |
121 |
$2K |