| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,693 |
2,622 |
$170K |
| D1110 |
Prophylaxis - adult |
3,125 |
3,021 |
$157K |
| D0120 |
Periodic oral evaluation - established patient |
5,197 |
5,039 |
$138K |
| D0274 |
Bitewings - four radiographic images |
4,225 |
4,113 |
$135K |
| D1206 |
Topical application of fluoride varnish |
4,908 |
4,763 |
$102K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
747 |
464 |
$98K |
| D1120 |
Prophylaxis - child |
2,664 |
2,598 |
$97K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
812 |
707 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,002 |
888 |
$37K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
315 |
186 |
$30K |
| D4346 |
|
255 |
252 |
$19K |
| D1351 |
Sealant - per tooth |
678 |
100 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
889 |
880 |
$16K |
| D0272 |
Bitewings - two radiographic images |
439 |
431 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
276 |
266 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
552 |
531 |
$10K |
| D9243 |
|
18 |
12 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
46 |
$3K |
| D9310 |
|
43 |
38 |
$2K |
| D9239 |
|
14 |
12 |
$2K |
| D1320 |
|
161 |
157 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
33 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
82 |
65 |
$553.00 |
| D0350 |
|
12 |
12 |
$468.00 |
| D1999 |
|
729 |
653 |
$0.00 |
| D9986 |
|
42 |
41 |
$0.00 |