| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9410 |
|
944 |
677 |
$92K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
648 |
253 |
$47K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
703 |
272 |
$39K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
332 |
325 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
787 |
730 |
$9K |
| D0274 |
Bitewings - four radiographic images |
258 |
255 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
628 |
538 |
$7K |
| D1110 |
Prophylaxis - adult |
78 |
77 |
$4K |
| D9110 |
|
61 |
59 |
$3K |
| D2330 |
|
42 |
15 |
$3K |
| D0272 |
Bitewings - two radiographic images |
119 |
119 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
92 |
92 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
57 |
53 |
$2K |