| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2752 |
|
677 |
466 |
$305K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,086 |
1,226 |
$247K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
430 |
397 |
$149K |
| D0274 |
Bitewings - four radiographic images |
2,791 |
2,688 |
$82K |
| D0230 |
Intraoral - periapical each additional radiographic image |
8,630 |
2,978 |
$76K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
897 |
440 |
$64K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,082 |
2,021 |
$63K |
| D0220 |
Intraoral - periapical first radiographic image |
5,703 |
4,697 |
$62K |
| D1110 |
Prophylaxis - adult |
1,341 |
1,295 |
$56K |
| D1351 |
Sealant - per tooth |
1,695 |
203 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,930 |
1,852 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,254 |
2,178 |
$41K |
| D0330 |
Panoramic radiographic image |
1,700 |
1,649 |
$37K |
| D1120 |
Prophylaxis - child |
945 |
914 |
$29K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
254 |
156 |
$22K |
| D0272 |
Bitewings - two radiographic images |
885 |
861 |
$18K |
| D2740 |
Crown - porcelain/ceramic |
22 |
13 |
$6K |
| D3331 |
|
56 |
41 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
151 |
143 |
$4K |
| D0460 |
|
181 |
110 |
$2K |
| D3110 |
|
42 |
32 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
12 |
12 |
$371.40 |
| D0364 |
|
1,069 |
1,021 |
$0.00 |