| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
3,523 |
2,635 |
$111K |
| D0120 |
Periodic oral evaluation - established patient |
1,845 |
1,837 |
$95K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,278 |
1,275 |
$77K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,173 |
641 |
$77K |
| D1110 |
Prophylaxis - adult |
685 |
683 |
$56K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,648 |
2,621 |
$51K |
| D0210 |
Intraoral - complete series of radiographic images |
1,064 |
1,061 |
$49K |
| D1120 |
Prophylaxis - child |
1,258 |
1,256 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,822 |
1,818 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
317 |
158 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
614 |
355 |
$33K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,614 |
1,610 |
$16K |
| D4341 |
|
216 |
66 |
$14K |
| D0350 |
|
1,211 |
487 |
$11K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
110 |
79 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
551 |
533 |
$6K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
77 |
43 |
$5K |
| D4910 |
|
44 |
44 |
$3K |
| D1206 |
Topical application of fluoride varnish |
145 |
145 |
$2K |
| D0330 |
Panoramic radiographic image |
51 |
50 |
$1K |
| D1999 |
|
60 |
57 |
$0.00 |