| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
2,265 |
1,815 |
$72K |
| D1110 |
Prophylaxis - adult |
584 |
584 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
870 |
868 |
$41K |
| D0230 |
Intraoral - periapical each additional radiographic image |
930 |
800 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
208 |
113 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
165 |
100 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
702 |
689 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
176 |
172 |
$8K |
| D0274 |
Bitewings - four radiographic images |
272 |
272 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
100 |
100 |
$4K |
| D1120 |
Prophylaxis - child |
128 |
126 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
66 |
39 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
298 |
291 |
$3K |
| D0330 |
Panoramic radiographic image |
64 |
64 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
14 |
12 |
$1K |
| D0350 |
|
57 |
44 |
$516.00 |
| D1330 |
|
16 |
15 |
$0.00 |