| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4249 |
|
7,347 |
1,727 |
$3.08M |
| D1510 |
|
2,496 |
550 |
$494K |
| D9952 |
|
1,100 |
996 |
$429K |
| D4241 |
|
2,547 |
620 |
$266K |
| D7970 |
|
873 |
724 |
$259K |
| D8210 |
|
408 |
225 |
$209K |
| D0290 |
|
821 |
755 |
$177K |
| D4342 |
|
2,569 |
658 |
$170K |
| D0460 |
|
5,135 |
2,271 |
$153K |
| D9951 |
|
1,453 |
1,305 |
$141K |
| D2750 |
|
268 |
115 |
$114K |
| D2710 |
|
309 |
134 |
$91K |
| D0140 |
Limited oral evaluation - problem focused |
2,110 |
1,849 |
$88K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,574 |
1,462 |
$83K |
| D1110 |
Prophylaxis - adult |
1,488 |
1,348 |
$82K |
| D7510 |
|
576 |
365 |
$61K |
| D4910 |
|
924 |
854 |
$60K |
| D4355 |
|
555 |
533 |
$58K |
| D0180 |
|
1,187 |
1,090 |
$53K |
| D0330 |
Panoramic radiographic image |
975 |
850 |
$51K |
| D5640 |
|
414 |
102 |
$46K |
| D0350 |
|
841 |
797 |
$44K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,763 |
1,628 |
$39K |
| D0340 |
|
373 |
355 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
198 |
91 |
$19K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
129 |
62 |
$16K |
| D5213 |
|
14 |
14 |
$14K |
| D0274 |
Bitewings - four radiographic images |
400 |
371 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
838 |
719 |
$11K |
| D5650 |
|
168 |
56 |
$10K |
| D0170 |
|
378 |
357 |
$7K |
| D7530 |
|
21 |
15 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
22 |
15 |
$3K |
| D4346 |
|
40 |
28 |
$2K |
| D1206 |
Topical application of fluoride varnish |
20 |
15 |
$464.00 |
| D0470 |
|
42 |
35 |
$80.00 |
| D5610 |
|
103 |
27 |
$0.00 |