| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,694 |
1,032 |
$68K |
| D0210 |
Intraoral - complete series of radiographic images |
934 |
650 |
$57K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,012 |
1,207 |
$56K |
| D1110 |
Prophylaxis - adult |
763 |
540 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,238 |
777 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
181 |
84 |
$18K |
| D0274 |
Bitewings - four radiographic images |
611 |
385 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
127 |
57 |
$12K |
| D0180 |
|
272 |
207 |
$10K |
| D1120 |
Prophylaxis - child |
463 |
194 |
$8K |
| D0120 |
Periodic oral evaluation - established patient |
235 |
211 |
$6K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
32 |
14 |
$5K |
| D4341 |
|
28 |
12 |
$5K |
| D1351 |
Sealant - per tooth |
299 |
29 |
$4K |
| D0272 |
Bitewings - two radiographic images |
263 |
95 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
135 |
88 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
29 |
26 |
$1K |