| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
920 |
893 |
$50K |
| D0140 |
Limited oral evaluation - problem focused |
1,597 |
1,422 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,382 |
1,093 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,385 |
1,349 |
$39K |
| D2332 |
|
325 |
102 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
258 |
161 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,024 |
1,520 |
$32K |
| D1110 |
Prophylaxis - adult |
753 |
727 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,091 |
1,987 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,033 |
987 |
$19K |
| D2954 |
|
137 |
87 |
$18K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
132 |
77 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
83 |
30 |
$5K |
| D2330 |
|
48 |
15 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
19 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
93 |
92 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
24 |
$1K |
| D1120 |
Prophylaxis - child |
14 |
13 |
$586.04 |
| D2940 |
|
16 |
12 |
$392.25 |
| D0270 |
|
13 |
12 |
$77.42 |