| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,341 |
427 |
$92K |
| D1110 |
Prophylaxis - adult |
809 |
799 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
771 |
767 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
455 |
450 |
$26K |
| D4910 |
|
276 |
276 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
398 |
396 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,736 |
722 |
$15K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
257 |
158 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,166 |
1,154 |
$13K |
| D1120 |
Prophylaxis - child |
257 |
257 |
$8K |
| D0272 |
Bitewings - two radiographic images |
571 |
563 |
$6K |
| D2330 |
|
76 |
56 |
$6K |
| D3320 |
|
16 |
12 |
$5K |
| D0350 |
|
301 |
170 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
29 |
25 |
$2K |
| D4342 |
|
39 |
16 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
30 |
16 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
86 |
84 |
$1K |
| D9110 |
|
12 |
12 |
$693.00 |