| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
786 |
367 |
$122K |
| D0120 |
Periodic oral evaluation - established patient |
4,046 |
3,824 |
$110K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,175 |
782 |
$103K |
| D1120 |
Prophylaxis - child |
2,358 |
2,229 |
$95K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,398 |
1,030 |
$91K |
| D1110 |
Prophylaxis - adult |
1,790 |
1,696 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,022 |
1,925 |
$52K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,531 |
3,702 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,812 |
1,729 |
$32K |
| D0210 |
Intraoral - complete series of radiographic images |
1,067 |
1,032 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
4,077 |
3,871 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
837 |
822 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
244 |
194 |
$12K |
| D0272 |
Bitewings - two radiographic images |
97 |
88 |
$939.37 |