| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,771 |
1,636 |
$117K |
| D1110 |
Prophylaxis - adult |
2,162 |
2,039 |
$108K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,110 |
598 |
$97K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,367 |
2,221 |
$91K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
673 |
402 |
$68K |
| D1351 |
Sealant - per tooth |
1,659 |
402 |
$63K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
768 |
411 |
$58K |
| D0274 |
Bitewings - four radiographic images |
1,514 |
1,411 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
558 |
133 |
$39K |
| D1206 |
Topical application of fluoride varnish |
1,326 |
1,262 |
$33K |
| D1120 |
Prophylaxis - child |
960 |
906 |
$31K |
| D0120 |
Periodic oral evaluation - established patient |
979 |
938 |
$29K |
| D0210 |
Intraoral - complete series of radiographic images |
879 |
451 |
$22K |
| D2335 |
|
137 |
73 |
$18K |
| D2332 |
|
103 |
56 |
$15K |
| D9945 |
|
58 |
57 |
$14K |
| D0272 |
Bitewings - two radiographic images |
490 |
457 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
106 |
95 |
$4K |
| D1354 |
|
135 |
37 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
529 |
141 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
289 |
267 |
$2K |
| D2394 |
|
18 |
12 |
$2K |