| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,713 |
1,687 |
$72K |
| D1110 |
Prophylaxis - adult |
2,055 |
2,045 |
$70K |
| D0120 |
Periodic oral evaluation - established patient |
3,220 |
3,207 |
$64K |
| D1206 |
Topical application of fluoride varnish |
2,986 |
2,979 |
$52K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
896 |
524 |
$50K |
| D0274 |
Bitewings - four radiographic images |
1,861 |
1,843 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,546 |
1,476 |
$32K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
741 |
445 |
$31K |
| D1120 |
Prophylaxis - child |
1,181 |
1,176 |
$28K |
| D1351 |
Sealant - per tooth |
957 |
229 |
$20K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
284 |
180 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
149 |
116 |
$12K |
| D0272 |
Bitewings - two radiographic images |
526 |
525 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
1,286 |
1,245 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
280 |
148 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
934 |
457 |
$7K |
| D2331 |
|
71 |
44 |
$6K |
| D2160 |
|
66 |
46 |
$6K |
| D2335 |
|
41 |
27 |
$4K |
| D2332 |
|
18 |
13 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
19 |
12 |
$2K |
| D2330 |
|
40 |
28 |
$2K |
| D2140 |
|
25 |
18 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
56 |
51 |
$905.52 |
| D1330 |
|
13 |
13 |
$81.03 |
| D1999 |
|
85 |
71 |
$0.00 |