| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,041 |
973 |
$66K |
| D1110 |
Prophylaxis - adult |
1,110 |
1,059 |
$63K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
511 |
300 |
$59K |
| D0140 |
Limited oral evaluation - problem focused |
1,336 |
1,277 |
$51K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,422 |
1,676 |
$47K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,249 |
1,986 |
$46K |
| D1120 |
Prophylaxis - child |
1,229 |
1,090 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,751 |
1,560 |
$43K |
| D0220 |
Intraoral - periapical first radiographic image |
2,320 |
2,070 |
$37K |
| D2740 |
Crown - porcelain/ceramic |
59 |
31 |
$34K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
319 |
167 |
$31K |
| D2950 |
|
135 |
75 |
$19K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
78 |
25 |
$11K |
| D0274 |
Bitewings - four radiographic images |
219 |
210 |
$9K |
| D1320 |
|
274 |
268 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
194 |
172 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
60 |
54 |
$5K |
| D1351 |
Sealant - per tooth |
157 |
25 |
$5K |
| D0272 |
Bitewings - two radiographic images |
186 |
161 |
$4K |
| D9630 |
|
90 |
82 |
$1K |
| D9310 |
|
14 |
14 |
$630.06 |