| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D4212 |
|
1,119 |
375 |
$364K |
| D1110 |
Prophylaxis - adult |
1,294 |
1,247 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
586 |
328 |
$42K |
| D0120 |
Periodic oral evaluation - established patient |
1,525 |
1,472 |
$35K |
| D0274 |
Bitewings - four radiographic images |
751 |
716 |
$26K |
| D0140 |
Limited oral evaluation - problem focused |
644 |
561 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
396 |
235 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
210 |
130 |
$17K |
| D0330 |
Panoramic radiographic image |
333 |
315 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
790 |
754 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
344 |
329 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,197 |
1,045 |
$11K |
| D1120 |
Prophylaxis - child |
352 |
341 |
$11K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
788 |
662 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
667 |
299 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
52 |
15 |
$8K |
| D0230 |
Intraoral - periapical each additional radiographic image |
868 |
637 |
$8K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
15 |
13 |
$7K |