| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,353 |
696 |
$90K |
| D0350 |
|
8,317 |
2,650 |
$78K |
| D0120 |
Periodic oral evaluation - established patient |
1,177 |
1,170 |
$72K |
| D9430 |
|
1,953 |
1,805 |
$62K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
919 |
919 |
$60K |
| D1110 |
Prophylaxis - adult |
507 |
507 |
$45K |
| D1120 |
Prophylaxis - child |
958 |
954 |
$40K |
| D0210 |
Intraoral - complete series of radiographic images |
688 |
688 |
$33K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,700 |
2,377 |
$19K |
| D0274 |
Bitewings - four radiographic images |
840 |
838 |
$18K |
| D4910 |
|
209 |
209 |
$16K |
| D1206 |
Topical application of fluoride varnish |
703 |
701 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
978 |
972 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
75 |
49 |
$6K |
| D4341 |
|
45 |
12 |
$3K |
| D0330 |
Panoramic radiographic image |
61 |
61 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
51 |
51 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
19 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
49 |
43 |
$578.00 |
| D9910 |
|
29 |
25 |
$0.00 |