| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
2,307 |
1,808 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,059 |
1,053 |
$69K |
| D0350 |
|
3,501 |
901 |
$31K |
| D1110 |
Prophylaxis - adult |
353 |
352 |
$30K |
| D0120 |
Periodic oral evaluation - established patient |
401 |
394 |
$28K |
| D0210 |
Intraoral - complete series of radiographic images |
540 |
538 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
186 |
105 |
$12K |
| D1120 |
Prophylaxis - child |
278 |
270 |
$11K |
| D1208 |
Topical application of fluoride, excluding varnish |
758 |
750 |
$10K |
| D4910 |
|
122 |
118 |
$9K |
| D0274 |
Bitewings - four radiographic images |
462 |
457 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,094 |
793 |
$8K |
| D1206 |
Topical application of fluoride varnish |
482 |
480 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
87 |
49 |
$5K |
| D4341 |
|
47 |
13 |
$3K |
| D0330 |
Panoramic radiographic image |
68 |
68 |
$2K |
| D9110 |
|
13 |
13 |
$819.00 |
| D0220 |
Intraoral - periapical first radiographic image |
54 |
54 |
$545.30 |
| D0270 |
|
13 |
12 |
$60.00 |
| D1999 |
|
99 |
87 |
$50.00 |