| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
5,273 |
5,174 |
$250K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,646 |
2,072 |
$194K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
4,142 |
1,308 |
$141K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,625 |
639 |
$129K |
| D0120 |
Periodic oral evaluation - established patient |
4,520 |
4,397 |
$110K |
| D2160 |
|
1,230 |
715 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,139 |
5,042 |
$74K |
| D2140 |
|
5,414 |
2,121 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,273 |
696 |
$60K |
| D1110 |
Prophylaxis - adult |
3,095 |
3,040 |
$59K |
| D5110 |
|
111 |
109 |
$39K |
| D4355 |
|
577 |
571 |
$29K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,978 |
970 |
$24K |
| D1120 |
Prophylaxis - child |
2,990 |
2,895 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,709 |
5,568 |
$11K |
| D2330 |
|
668 |
347 |
$9K |
| D5213 |
|
14 |
14 |
$7K |
| D0140 |
Limited oral evaluation - problem focused |
712 |
688 |
$6K |
| D1330 |
|
8,376 |
8,160 |
$6K |
| D2331 |
|
227 |
140 |
$5K |
| D5214 |
|
14 |
14 |
$4K |
| D2161 |
|
19 |
17 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
99 |
99 |
$2K |
| D0272 |
Bitewings - two radiographic images |
1,976 |
1,920 |
$1K |
| D1351 |
Sealant - per tooth |
73 |
16 |
$1K |
| D0274 |
Bitewings - four radiographic images |
207 |
207 |
$841.77 |
| D0220 |
Intraoral - periapical first radiographic image |
31 |
15 |
$10.98 |
| D8670 |
Periodic orthodontic treatment visit |
21 |
21 |
$0.00 |