| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2721 |
|
791 |
247 |
$233K |
| D9243 |
|
3,977 |
504 |
$77K |
| D4341 |
|
1,914 |
239 |
$60K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,693 |
360 |
$56K |
| D4342 |
|
3,149 |
446 |
$53K |
| D4910 |
|
1,260 |
623 |
$45K |
| D0210 |
Intraoral - complete series of radiographic images |
1,416 |
761 |
$36K |
| D1206 |
Topical application of fluoride varnish |
3,270 |
1,679 |
$35K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,423 |
1,069 |
$32K |
| D9239 |
|
1,076 |
493 |
$25K |
| D4355 |
|
627 |
319 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
489 |
189 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
1,092 |
579 |
$13K |
| D0274 |
Bitewings - four radiographic images |
863 |
421 |
$11K |
| D9248 |
|
307 |
112 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
747 |
389 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
825 |
247 |
$3K |
| D9110 |
|
179 |
94 |
$3K |
| D0160 |
|
210 |
82 |
$3K |
| D2332 |
|
60 |
17 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
33 |
14 |
$2K |
| D1110 |
Prophylaxis - adult |
44 |
39 |
$2K |
| D2330 |
|
51 |
13 |
$1K |
| D0330 |
Panoramic radiographic image |
36 |
25 |
$1K |
| D0470 |
|
107 |
56 |
$375.34 |
| D1208 |
Topical application of fluoride, excluding varnish |
31 |
16 |
$360.80 |
| D9910 |
|
54 |
29 |
$0.00 |
| D0460 |
|
297 |
126 |
$0.00 |
| D9920 |
|
470 |
54 |
$0.00 |