| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
3,927 |
1,864 |
$137K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,932 |
1,841 |
$70K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
713 |
526 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,661 |
1,606 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,034 |
1,003 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
556 |
352 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,751 |
982 |
$26K |
| D0210 |
Intraoral - complete series of radiographic images |
696 |
659 |
$23K |
| D1110 |
Prophylaxis - adult |
389 |
376 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,179 |
1,095 |
$13K |
| D0274 |
Bitewings - four radiographic images |
1,037 |
988 |
$13K |
| D4910 |
|
233 |
222 |
$11K |
| D4346 |
|
117 |
106 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
62 |
54 |
$5K |
| D1999 |
|
159 |
110 |
$2K |
| D0330 |
Panoramic radiographic image |
175 |
162 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
25 |
14 |
$988.00 |
| D0272 |
Bitewings - two radiographic images |
42 |
41 |
$458.21 |
| D0270 |
|
16 |
13 |
$65.00 |
| D9630 |
|
15 |
15 |
$40.00 |