| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4212 |
|
1,927 |
489 |
$681K |
| D4346 |
|
1,058 |
972 |
$200K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,300 |
1,101 |
$177K |
| D1354 |
|
2,512 |
376 |
$143K |
| D1110 |
Prophylaxis - adult |
2,913 |
2,735 |
$139K |
| D0274 |
Bitewings - four radiographic images |
3,672 |
3,363 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,345 |
2,203 |
$89K |
| D1351 |
Sealant - per tooth |
3,191 |
511 |
$87K |
| D0120 |
Periodic oral evaluation - established patient |
3,866 |
3,615 |
$85K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,394 |
605 |
$84K |
| D1206 |
Topical application of fluoride varnish |
3,909 |
3,673 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
3,170 |
2,178 |
$66K |
| D1120 |
Prophylaxis - child |
1,826 |
1,716 |
$57K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,188 |
2,428 |
$55K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
489 |
290 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,546 |
3,106 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
234 |
85 |
$39K |
| D0330 |
Panoramic radiographic image |
681 |
603 |
$23K |
| D2394 |
|
182 |
116 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
388 |
358 |
$11K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
12 |
$11K |
| D0272 |
Bitewings - two radiographic images |
267 |
253 |
$6K |
| D2949 |
|
28 |
13 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
24 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
64 |
28 |
$1K |
| D9920 |
|
17 |
12 |
$759.76 |
| D0240 |
|
51 |
24 |
$666.00 |
| D1999 |
|
1,523 |
1,242 |
$20.00 |
| D0603 |
|
75 |
67 |
$0.00 |