| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
271 |
265 |
$110K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,133 |
1,054 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,767 |
1,681 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
834 |
832 |
$25K |
| D1110 |
Prophylaxis - adult |
133 |
133 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
283 |
283 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
42 |
25 |
$4K |
| D2954 |
|
24 |
24 |
$3K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
30 |
14 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
121 |
121 |
$3K |
| D0274 |
Bitewings - four radiographic images |
52 |
52 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
111 |
76 |
$812.25 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$603.85 |
| D2940 |
|
12 |
12 |
$522.72 |
| D1120 |
Prophylaxis - child |
13 |
13 |
$377.65 |