| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,543 |
1,221 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
178 |
83 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
212 |
90 |
$18K |
| D1110 |
Prophylaxis - adult |
312 |
309 |
$15K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
26 |
25 |
$11K |
| D0240 |
|
1,152 |
533 |
$9K |
| D2950 |
|
114 |
74 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
555 |
446 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
148 |
148 |
$5K |
| D9310 |
|
51 |
51 |
$5K |
| D9110 |
|
110 |
102 |
$5K |
| D4341 |
|
109 |
28 |
$5K |
| D2330 |
|
48 |
26 |
$5K |
| D0274 |
Bitewings - four radiographic images |
149 |
144 |
$4K |
| D0330 |
Panoramic radiographic image |
57 |
57 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
61 |
50 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
187 |
130 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
100 |
49 |
$1K |
| D9920 |
|
60 |
48 |
$0.00 |