| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,796 |
3,518 |
$126K |
| D1110 |
Prophylaxis - adult |
3,759 |
3,539 |
$125K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,785 |
4,469 |
$108K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,474 |
840 |
$91K |
| D0274 |
Bitewings - four radiographic images |
4,304 |
4,042 |
$75K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,594 |
879 |
$63K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,606 |
818 |
$58K |
| D1120 |
Prophylaxis - child |
1,274 |
1,179 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
918 |
599 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
2,071 |
1,931 |
$36K |
| D1351 |
Sealant - per tooth |
1,970 |
472 |
$31K |
| D2335 |
|
438 |
261 |
$30K |
| D2332 |
|
547 |
309 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,936 |
1,820 |
$27K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
493 |
311 |
$27K |
| D2394 |
|
376 |
257 |
$25K |
| D0220 |
Intraoral - periapical first radiographic image |
5,568 |
5,084 |
$25K |
| D4341 |
|
279 |
108 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,751 |
3,931 |
$18K |
| D0140 |
Limited oral evaluation - problem focused |
518 |
469 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
108 |
104 |
$5K |
| D0272 |
Bitewings - two radiographic images |
255 |
237 |
$4K |
| D2140 |
|
54 |
16 |
$2K |
| D2330 |
|
50 |
30 |
$2K |
| D9110 |
|
87 |
82 |
$2K |
| D2161 |
|
22 |
15 |
$2K |
| D2331 |
|
33 |
25 |
$2K |