| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,337 |
2,123 |
$106K |
| D0140 |
Limited oral evaluation - problem focused |
2,983 |
2,619 |
$100K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,278 |
589 |
$82K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,954 |
2,278 |
$79K |
| D1120 |
Prophylaxis - child |
3,658 |
2,982 |
$78K |
| D7140 |
Extraction, erupted tooth or exposed root |
745 |
413 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
543 |
292 |
$43K |
| D1206 |
Topical application of fluoride varnish |
2,282 |
1,859 |
$41K |
| D0274 |
Bitewings - four radiographic images |
1,814 |
1,437 |
$37K |
| D0120 |
Periodic oral evaluation - established patient |
839 |
786 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
1,597 |
1,124 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,344 |
1,056 |
$14K |
| D0210 |
Intraoral - complete series of radiographic images |
261 |
144 |
$9K |