| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
857 |
856 |
$59K |
| D9999 |
Unspecified adjunctive procedure, by report |
299 |
288 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
553 |
551 |
$32K |
| D0120 |
Periodic oral evaluation - established patient |
605 |
604 |
$29K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,746 |
1,571 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,032 |
1,029 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,068 |
1,066 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
141 |
51 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,677 |
1,634 |
$12K |
| D4341 |
|
150 |
41 |
$10K |
| D9430 |
|
341 |
286 |
$9K |
| D1120 |
Prophylaxis - child |
157 |
155 |
$6K |
| D1320 |
|
317 |
317 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
65 |
65 |
$2K |
| D1999 |
|
216 |
212 |
$1K |
| D0999 |
Unspecified diagnostic procedure, by report |
12 |
12 |
$720.00 |
| D9995 |
|
16 |
13 |
$345.60 |