| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,746 |
1,724 |
$76K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,144 |
771 |
$59K |
| D1110 |
Prophylaxis - adult |
1,787 |
1,765 |
$56K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,171 |
2,156 |
$55K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,042 |
700 |
$51K |
| D1120 |
Prophylaxis - child |
2,306 |
2,281 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
2,669 |
2,635 |
$43K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,008 |
3,961 |
$43K |
| D1351 |
Sealant - per tooth |
1,867 |
550 |
$39K |
| D7140 |
Extraction, erupted tooth or exposed root |
677 |
471 |
$36K |
| D0140 |
Limited oral evaluation - problem focused |
1,092 |
1,058 |
$23K |
| D0274 |
Bitewings - four radiographic images |
1,808 |
1,782 |
$16K |
| D0272 |
Bitewings - two radiographic images |
1,149 |
1,133 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
2,704 |
2,609 |
$8K |
| D1320 |
|
193 |
184 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,911 |
1,583 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
53 |
44 |
$3K |
| D2330 |
|
21 |
12 |
$1K |