| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
959 |
949 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
1,407 |
1,402 |
$69K |
| D4341 |
|
921 |
263 |
$58K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
999 |
992 |
$56K |
| D1110 |
Prophylaxis - adult |
510 |
507 |
$42K |
| D0210 |
Intraoral - complete series of radiographic images |
738 |
731 |
$30K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,468 |
1,971 |
$26K |
| D9951 |
|
794 |
704 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,567 |
1,562 |
$23K |
| D0220 |
Intraoral - periapical first radiographic image |
1,970 |
1,843 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
258 |
107 |
$15K |
| D9430 |
|
498 |
475 |
$15K |
| D1120 |
Prophylaxis - child |
444 |
442 |
$14K |
| D0274 |
Bitewings - four radiographic images |
681 |
680 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
28 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
65 |
12 |
$1K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$132.00 |