| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4212 |
|
2,336 |
604 |
$842K |
| D2949 |
|
2,138 |
523 |
$333K |
| D2335 |
|
954 |
272 |
$144K |
| D2394 |
|
624 |
282 |
$80K |
| D2990 |
|
331 |
71 |
$40K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
800 |
744 |
$32K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
326 |
116 |
$32K |
| D0140 |
Limited oral evaluation - problem focused |
395 |
371 |
$16K |
| D0272 |
Bitewings - two radiographic images |
462 |
427 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
725 |
361 |
$9K |
| D4346 |
|
44 |
41 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
422 |
392 |
$6K |
| D1110 |
Prophylaxis - adult |
102 |
98 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
95 |
76 |
$6K |
| D2390 |
|
52 |
12 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
217 |
190 |
$2K |
| D0274 |
Bitewings - four radiographic images |
26 |
24 |
$1K |