| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2335 |
|
1,254 |
285 |
$144K |
| D9951 |
|
2,133 |
542 |
$73K |
| D2394 |
|
593 |
159 |
$49K |
| D1110 |
Prophylaxis - adult |
453 |
450 |
$39K |
| D9110 |
|
486 |
401 |
$30K |
| D9910 |
|
306 |
301 |
$18K |
| D4910 |
|
220 |
217 |
$17K |
| D1206 |
Topical application of fluoride varnish |
871 |
864 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
209 |
208 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
203 |
202 |
$13K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
225 |
85 |
$12K |
| D7510 |
|
142 |
124 |
$10K |
| D0350 |
|
726 |
219 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
435 |
220 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
108 |
106 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
17 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
48 |
15 |
$3K |
| D0274 |
Bitewings - four radiographic images |
111 |
111 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
394 |
175 |
$2K |
| D1120 |
Prophylaxis - child |
13 |
12 |
$360.00 |
| D1999 |
|
21 |
13 |
$0.00 |