| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,956 |
1,860 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
988 |
489 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
461 |
297 |
$2K |
| D0274 |
Bitewings - four radiographic images |
2,667 |
2,560 |
$2K |
| D1120 |
Prophylaxis - child |
1,233 |
1,225 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
4,212 |
3,819 |
$2K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,165 |
1,146 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
1,262 |
1,208 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,109 |
3,115 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
423 |
268 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,660 |
1,635 |
$1K |
| D1110 |
Prophylaxis - adult |
874 |
865 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
1,192 |
1,177 |
$725.43 |
| D1206 |
Topical application of fluoride varnish |
371 |
370 |
$45.48 |
| D1999 |
|
703 |
528 |
$0.00 |
| D0270 |
|
53 |
49 |
$0.00 |
| D2740 |
Crown - porcelain/ceramic |
15 |
13 |
$0.00 |
| D2950 |
|
17 |
15 |
$0.00 |