| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
399 |
390 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
139 |
68 |
$11K |
| D0274 |
Bitewings - four radiographic images |
505 |
497 |
$10K |
| D0330 |
Panoramic radiographic image |
144 |
139 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
1,111 |
1,003 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
485 |
437 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
246 |
245 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
884 |
673 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
479 |
469 |
$5K |
| D1110 |
Prophylaxis - adult |
65 |
65 |
$2K |
| D4355 |
|
13 |
12 |
$1K |
| D9994 |
|
490 |
482 |
$673.84 |
| D4342 |
|
40 |
12 |
$255.20 |
| D9610 |
|
393 |
385 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
158 |
68 |
$0.00 |
| D2950 |
|
149 |
76 |
$0.00 |