| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D9610 |
|
1,050 |
655 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
732 |
252 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
375 |
181 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
494 |
173 |
$15K |
| D7230 |
|
148 |
49 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
760 |
524 |
$13K |
| D4341 |
|
687 |
151 |
$12K |
| D0210 |
Intraoral - complete series of radiographic images |
393 |
363 |
$10K |
| D1110 |
Prophylaxis - adult |
291 |
277 |
$8K |
| D2331 |
|
188 |
38 |
$7K |
| D1206 |
Topical application of fluoride varnish |
416 |
385 |
$5K |
| D9110 |
|
118 |
101 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
196 |
174 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
287 |
211 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
188 |
60 |
$223.62 |
| D0460 |
|
90 |
73 |
$9.70 |