| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9430 |
|
965 |
668 |
$31K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
326 |
326 |
$22K |
| D1110 |
Prophylaxis - adult |
157 |
157 |
$14K |
| D0350 |
|
1,386 |
369 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
244 |
244 |
$12K |
| D4341 |
|
150 |
39 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
146 |
85 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
118 |
66 |
$8K |
| D4910 |
|
65 |
65 |
$5K |
| D1206 |
Topical application of fluoride varnish |
338 |
338 |
$5K |
| D9110 |
|
66 |
66 |
$4K |
| D1120 |
Prophylaxis - child |
56 |
56 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
147 |
142 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
405 |
174 |
$2K |
| D0274 |
Bitewings - four radiographic images |
20 |
20 |
$410.40 |
| D0270 |
|
14 |
12 |
$70.00 |