| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0350 |
|
5,527 |
1,486 |
$51K |
| D0120 |
Periodic oral evaluation - established patient |
484 |
477 |
$29K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
416 |
186 |
$28K |
| D1110 |
Prophylaxis - adult |
294 |
293 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
380 |
380 |
$25K |
| D9430 |
|
691 |
567 |
$22K |
| D0210 |
Intraoral - complete series of radiographic images |
401 |
401 |
$19K |
| D4910 |
|
211 |
211 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
973 |
961 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,394 |
935 |
$10K |
| D0274 |
Bitewings - four radiographic images |
442 |
433 |
$9K |
| D1120 |
Prophylaxis - child |
218 |
208 |
$8K |
| D4341 |
|
56 |
14 |
$4K |
| D1320 |
|
181 |
181 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
27 |
$3K |
| D0270 |
|
29 |
26 |
$145.00 |
| D1330 |
|
34 |
34 |
$0.00 |