| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,747 |
1,744 |
$108K |
| D1110 |
Prophylaxis - adult |
1,912 |
1,910 |
$93K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,014 |
2,014 |
$66K |
| D0274 |
Bitewings - four radiographic images |
1,929 |
1,929 |
$62K |
| D0120 |
Periodic oral evaluation - established patient |
1,737 |
1,733 |
$53K |
| D1206 |
Topical application of fluoride varnish |
1,922 |
1,919 |
$47K |
| D1120 |
Prophylaxis - child |
1,301 |
1,299 |
$45K |
| D0140 |
Limited oral evaluation - problem focused |
1,198 |
1,164 |
$39K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
500 |
240 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,331 |
1,494 |
$32K |
| D0220 |
Intraoral - periapical first radiographic image |
1,993 |
1,957 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
312 |
156 |
$23K |
| D0272 |
Bitewings - two radiographic images |
349 |
349 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
129 |
69 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
72 |
38 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
53 |
14 |
$1K |
| D2160 |
|
18 |
12 |
$1K |
| D2140 |
|
26 |
13 |
$1K |
| D4910 |
|
15 |
15 |
$631.76 |
| D1999 |
|
64 |
55 |
$0.00 |