| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
2,745 |
2,660 |
$63K |
| D0330 |
Panoramic radiographic image |
1,399 |
1,366 |
$56K |
| D1120 |
Prophylaxis - child |
1,232 |
1,203 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,780 |
1,746 |
$52K |
| D0220 |
Intraoral - periapical first radiographic image |
3,012 |
2,908 |
$40K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
633 |
342 |
$37K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,080 |
3,264 |
$24K |
| D0120 |
Periodic oral evaluation - established patient |
1,087 |
1,029 |
$21K |
| D1110 |
Prophylaxis - adult |
1,031 |
985 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
518 |
506 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,179 |
1,155 |
$12K |
| D1351 |
Sealant - per tooth |
369 |
95 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
131 |
58 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
64 |
27 |
$2K |
| D0999 |
Unspecified diagnostic procedure, by report |
17 |
17 |
$510.00 |