| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
2,409 |
2,247 |
$262K |
| D4342 |
|
1,415 |
407 |
$200K |
| D4341 |
|
973 |
207 |
$162K |
| D1206 |
Topical application of fluoride varnish |
5,337 |
4,383 |
$154K |
| D9420 |
|
734 |
724 |
$141K |
| D1110 |
Prophylaxis - adult |
1,787 |
1,723 |
$120K |
| D0120 |
Periodic oral evaluation - established patient |
3,784 |
2,981 |
$118K |
| D0210 |
Intraoral - complete series of radiographic images |
1,120 |
929 |
$98K |
| D0274 |
Bitewings - four radiographic images |
1,092 |
1,016 |
$47K |
| D0220 |
Intraoral - periapical first radiographic image |
1,889 |
1,738 |
$35K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
201 |
104 |
$26K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,405 |
1,298 |
$25K |
| D2740 |
Crown - porcelain/ceramic |
35 |
24 |
$23K |
| D9410 |
|
38 |
38 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
58 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
63 |
56 |
$3K |