| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,921 |
1,591 |
$87K |
| D1110 |
Prophylaxis - adult |
2,383 |
1,942 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,046 |
522 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
2,042 |
1,504 |
$44K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,511 |
1,269 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
2,195 |
1,743 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,328 |
1,058 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,370 |
1,034 |
$21K |
| D1320 |
|
1,265 |
1,108 |
$19K |
| D1120 |
Prophylaxis - child |
801 |
599 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
2,039 |
1,510 |
$10K |
| D1206 |
Topical application of fluoride varnish |
558 |
525 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
105 |
38 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
318 |
182 |
$1K |
| D1351 |
Sealant - per tooth |
57 |
13 |
$1K |
| D1321 |
|
86 |
83 |
$1K |
| D0272 |
Bitewings - two radiographic images |
85 |
48 |
$810.00 |
| D1999 |
|
611 |
538 |
$0.00 |