| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2330 |
|
1,309 |
616 |
$100K |
| D9110 |
|
1,518 |
1,413 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,471 |
1,466 |
$91K |
| D0210 |
Intraoral - complete series of radiographic images |
1,129 |
1,125 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
773 |
339 |
$51K |
| D1110 |
Prophylaxis - adult |
649 |
642 |
$50K |
| D4910 |
|
623 |
623 |
$47K |
| D9430 |
|
843 |
816 |
$27K |
| D5630 |
|
109 |
67 |
$15K |
| D4341 |
|
194 |
54 |
$14K |
| D2331 |
|
154 |
72 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
96 |
53 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
197 |
197 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
162 |
90 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
616 |
612 |
$8K |
| D5640 |
|
78 |
27 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
306 |
286 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
687 |
324 |
$3K |
| D1120 |
Prophylaxis - child |
54 |
54 |
$2K |
| D5850 |
|
25 |
24 |
$2K |
| D2160 |
|
20 |
13 |
$2K |
| D0274 |
Bitewings - four radiographic images |
74 |
74 |
$2K |
| D9410 |
|
56 |
51 |
$2K |
| D5610 |
|
19 |
12 |
$2K |
| D5851 |
|
12 |
12 |
$840.00 |
| D1206 |
Topical application of fluoride varnish |
31 |
31 |
$261.50 |