| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4341 |
|
1,097 |
491 |
$90K |
| D1110 |
Prophylaxis - adult |
1,132 |
1,105 |
$51K |
| D0330 |
Panoramic radiographic image |
1,005 |
977 |
$38K |
| D0274 |
Bitewings - four radiographic images |
1,534 |
1,485 |
$37K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,104 |
2,054 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,050 |
1,016 |
$37K |
| D2394 |
|
212 |
148 |
$19K |
| D4342 |
|
274 |
153 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
554 |
529 |
$14K |
| D2335 |
|
127 |
66 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
199 |
131 |
$13K |
| D4355 |
|
252 |
245 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
952 |
595 |
$11K |
| D4910 |
|
174 |
169 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
941 |
339 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
54 |
33 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
124 |
111 |
$3K |
| D0603 |
|
95 |
95 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
17 |
14 |
$952.00 |
| D1999 |
|
106 |
93 |
$707.00 |
| D1330 |
|
194 |
194 |
$450.00 |
| D9630 |
|
15 |
15 |
$285.00 |