| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
2,813 |
2,295 |
$89K |
| D0120 |
Periodic oral evaluation - established patient |
1,315 |
1,302 |
$68K |
| D1120 |
Prophylaxis - child |
809 |
801 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,334 |
1,456 |
$29K |
| D1110 |
Prophylaxis - adult |
272 |
272 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,754 |
1,740 |
$21K |
| D4910 |
|
196 |
196 |
$15K |
| D0274 |
Bitewings - four radiographic images |
712 |
710 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
241 |
241 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
143 |
143 |
$9K |
| D1320 |
|
260 |
258 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
35 |
14 |
$2K |
| D2940 |
|
57 |
13 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
95 |
93 |
$1K |