| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2722 |
|
854 |
474 |
$918K |
| D2950 |
|
1,080 |
653 |
$209K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,233 |
3,992 |
$154K |
| D1110 |
Prophylaxis - adult |
2,082 |
2,072 |
$133K |
| D1206 |
Topical application of fluoride varnish |
2,490 |
2,476 |
$81K |
| D0220 |
Intraoral - periapical first radiographic image |
4,584 |
4,286 |
$80K |
| D0330 |
Panoramic radiographic image |
799 |
799 |
$77K |
| D0274 |
Bitewings - four radiographic images |
1,669 |
1,665 |
$73K |
| D5226 |
|
41 |
40 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
1,764 |
1,751 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
924 |
924 |
$46K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
54 |
52 |
$38K |
| D1330 |
|
750 |
749 |
$29K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
171 |
75 |
$27K |
| D0140 |
Limited oral evaluation - problem focused |
602 |
584 |
$26K |
| D2332 |
|
87 |
50 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
110 |
110 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
79 |
30 |
$9K |
| D1120 |
Prophylaxis - child |
134 |
134 |
$5K |
| D1351 |
Sealant - per tooth |
111 |
29 |
$5K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
23 |
12 |
$3K |
| D9985 |
|
56 |
48 |
$0.00 |