| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,507 |
1,493 |
$118K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,343 |
1,335 |
$82K |
| D0220 |
Intraoral - periapical first radiographic image |
2,654 |
2,358 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,587 |
2,533 |
$27K |
| D0350 |
|
3,133 |
1,755 |
$24K |
| D4341 |
|
249 |
67 |
$17K |
| D0330 |
Panoramic radiographic image |
667 |
656 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
224 |
135 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
261 |
259 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
263 |
261 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
184 |
101 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
335 |
334 |
$4K |
| D2920 |
|
100 |
95 |
$4K |
| D4910 |
|
48 |
48 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
24 |
$2K |
| D0270 |
|
32 |
14 |
$70.00 |