| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,674 |
1,667 |
$144K |
| D0120 |
Periodic oral evaluation - established patient |
2,161 |
2,151 |
$131K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,349 |
3,063 |
$39K |
| D4910 |
|
510 |
500 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,839 |
2,828 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
637 |
351 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,458 |
1,453 |
$31K |
| D1120 |
Prophylaxis - child |
794 |
793 |
$29K |
| D0350 |
|
2,315 |
1,023 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
387 |
385 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,766 |
1,698 |
$21K |
| D9430 |
|
588 |
573 |
$18K |
| D1320 |
|
1,128 |
1,115 |
$16K |
| D4341 |
|
188 |
50 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
279 |
279 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
107 |
75 |
$7K |
| D2330 |
|
43 |
24 |
$3K |
| D2332 |
|
21 |
13 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
12 |
$1K |