| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
410 |
113 |
$27K |
| D4910 |
|
230 |
230 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
324 |
321 |
$17K |
| D1110 |
Prophylaxis - adult |
246 |
243 |
$17K |
| D0210 |
Intraoral - complete series of radiographic images |
322 |
316 |
$14K |
| D0350 |
|
1,594 |
544 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
117 |
71 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
131 |
74 |
$9K |
| D0120 |
Periodic oral evaluation - established patient |
165 |
163 |
$5K |
| D1208 |
Topical application of fluoride, excluding varnish |
397 |
390 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,003 |
290 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
40 |
39 |
$480.00 |