| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
941 |
906 |
$42K |
| D1110 |
Prophylaxis - adult |
1,148 |
1,115 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
794 |
771 |
$20K |
| D0140 |
Limited oral evaluation - problem focused |
914 |
801 |
$20K |
| D0120 |
Periodic oral evaluation - established patient |
1,102 |
1,078 |
$18K |
| D0274 |
Bitewings - four radiographic images |
615 |
609 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
208 |
117 |
$12K |
| D1208 |
Topical application of fluoride, excluding varnish |
640 |
628 |
$9K |
| D1120 |
Prophylaxis - child |
377 |
373 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
992 |
867 |
$5K |
| D1320 |
|
321 |
313 |
$5K |
| D1351 |
Sealant - per tooth |
64 |
16 |
$1K |
| D1321 |
|
71 |
71 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
15 |
12 |
$756.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
26 |
24 |
$130.00 |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$130.00 |
| D1999 |
|
1,304 |
1,093 |
$0.00 |