| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
2,041 |
2,027 |
$156K |
| D1110 |
Prophylaxis - adult |
1,767 |
1,756 |
$148K |
| D0120 |
Periodic oral evaluation - established patient |
2,216 |
2,200 |
$125K |
| D4341 |
|
1,414 |
412 |
$99K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,198 |
491 |
$62K |
| D0230 |
Intraoral - periapical each additional radiographic image |
9,120 |
2,113 |
$39K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,782 |
2,761 |
$36K |
| D0210 |
Intraoral - complete series of radiographic images |
638 |
635 |
$28K |
| D1120 |
Prophylaxis - child |
706 |
694 |
$24K |
| D9430 |
|
704 |
702 |
$23K |
| D2330 |
|
243 |
124 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
270 |
267 |
$16K |
| D2791 |
|
15 |
12 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
117 |
66 |
$7K |
| D0272 |
Bitewings - two radiographic images |
518 |
516 |
$6K |
| D2394 |
|
40 |
26 |
$3K |
| D2952 |
|
14 |
12 |
$1K |
| D0274 |
Bitewings - four radiographic images |
60 |
60 |
$1K |
| D4342 |
|
29 |
12 |
$1K |
| D9110 |
|
16 |
16 |
$1K |