| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9947 |
|
25 |
25 |
$57K |
| D2332 |
|
547 |
164 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
535 |
469 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
453 |
225 |
$22K |
| D1110 |
Prophylaxis - adult |
481 |
466 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
251 |
157 |
$15K |
| D5213 |
|
25 |
25 |
$13K |
| D1320 |
|
519 |
503 |
$10K |
| D0210 |
Intraoral - complete series of radiographic images |
144 |
142 |
$6K |
| D0274 |
Bitewings - four radiographic images |
213 |
204 |
$6K |
| D5214 |
|
13 |
13 |
$6K |
| D2330 |
|
105 |
48 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
242 |
238 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
223 |
212 |
$4K |
| D1330 |
|
382 |
371 |
$4K |
| D1310 |
|
386 |
374 |
$4K |
| D2331 |
|
56 |
38 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
275 |
261 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
195 |
171 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$1K |
| D1999 |
|
38 |
31 |
$360.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
14 |
14 |
$261.54 |