| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9239 |
|
428 |
346 |
$217K |
| D1110 |
Prophylaxis - adult |
1,604 |
1,463 |
$139K |
| D9243 |
|
792 |
347 |
$139K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,624 |
1,134 |
$41K |
| D0210 |
Intraoral - complete series of radiographic images |
131 |
122 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
271 |
95 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
976 |
865 |
$10K |
| D1206 |
Topical application of fluoride varnish |
1,589 |
1,446 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
24 |
12 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
44 |
27 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
1,286 |
1,155 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
60 |
58 |
$2K |
| D0274 |
Bitewings - four radiographic images |
626 |
523 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
119 |
109 |
$2K |