| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
1,107 |
920 |
$471K |
| D1110 |
Prophylaxis - adult |
4,486 |
4,458 |
$218K |
| D2950 |
|
1,772 |
1,382 |
$206K |
| D0120 |
Periodic oral evaluation - established patient |
5,508 |
5,474 |
$153K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
3,980 |
3,787 |
$142K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,460 |
966 |
$135K |
| D1120 |
Prophylaxis - child |
3,018 |
2,987 |
$102K |
| D2931 |
|
562 |
428 |
$97K |
| D0272 |
Bitewings - two radiographic images |
4,585 |
4,544 |
$92K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,449 |
4,423 |
$90K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,294 |
1,241 |
$56K |
| D0220 |
Intraoral - periapical first radiographic image |
2,857 |
2,801 |
$37K |
| D0140 |
Limited oral evaluation - problem focused |
1,832 |
1,796 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
145 |
115 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,689 |
954 |
$12K |
| D0330 |
Panoramic radiographic image |
223 |
218 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
163 |
108 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
42 |
41 |
$2K |
| D9420 |
|
25 |
24 |
$1K |
| D1999 |
|
17 |
17 |
$20.00 |