| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
526 |
338 |
$235K |
| D1351 |
Sealant - per tooth |
6,114 |
899 |
$136K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
218 |
189 |
$71K |
| D2954 |
|
539 |
348 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
814 |
409 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
701 |
361 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,005 |
975 |
$28K |
| D0330 |
Panoramic radiographic image |
935 |
908 |
$25K |
| D1120 |
Prophylaxis - child |
891 |
867 |
$22K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,173 |
1,144 |
$19K |
| D0220 |
Intraoral - periapical first radiographic image |
2,316 |
1,514 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
841 |
821 |
$17K |
| D0274 |
Bitewings - four radiographic images |
509 |
499 |
$14K |
| D2330 |
|
214 |
90 |
$13K |
| D0272 |
Bitewings - two radiographic images |
661 |
642 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
160 |
92 |
$12K |
| D1110 |
Prophylaxis - adult |
356 |
350 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
745 |
382 |
$6K |
| D3310 |
|
23 |
12 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
122 |
112 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
163 |
142 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
26 |
16 |
$2K |
| D0364 |
|
109 |
99 |
$0.00 |