| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4910 |
|
1,123 |
1,114 |
$85K |
| D1110 |
Prophylaxis - adult |
855 |
840 |
$68K |
| D9110 |
|
1,049 |
917 |
$65K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
968 |
964 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
869 |
868 |
$53K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
574 |
298 |
$38K |
| D2751 |
Crown - porcelain fused to predominantly base metal |
55 |
39 |
$26K |
| D4341 |
|
362 |
101 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
460 |
221 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,574 |
1,542 |
$20K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,507 |
1,481 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
267 |
262 |
$12K |
| D0274 |
Bitewings - four radiographic images |
494 |
471 |
$10K |
| D0350 |
|
982 |
381 |
$9K |
| D1120 |
Prophylaxis - child |
183 |
167 |
$6K |
| D0272 |
Bitewings - two radiographic images |
359 |
359 |
$4K |
| D2330 |
|
44 |
14 |
$4K |
| D9430 |
|
46 |
45 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
16 |
12 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
53 |
51 |
$602.00 |
| D0270 |
|
20 |
20 |
$100.00 |
| D9993 |
|
23 |
23 |
$0.00 |
| D0603 |
|
22 |
22 |
$0.00 |
| D1310 |
|
23 |
23 |
$0.00 |