| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0274 |
Bitewings - four radiographic images |
3,453 |
3,382 |
$104K |
| D1110 |
Prophylaxis - adult |
2,247 |
2,186 |
$71K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,453 |
3,372 |
$71K |
| D0120 |
Periodic oral evaluation - established patient |
2,883 |
2,833 |
$70K |
| D1120 |
Prophylaxis - child |
1,560 |
1,531 |
$68K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,965 |
1,509 |
$63K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
708 |
373 |
$60K |
| D0330 |
Panoramic radiographic image |
1,424 |
924 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,877 |
1,817 |
$50K |
| D2332 |
|
412 |
212 |
$44K |
| D7970 |
|
342 |
323 |
$39K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
456 |
164 |
$36K |
| D0220 |
Intraoral - periapical first radiographic image |
2,826 |
2,726 |
$29K |
| D2394 |
|
226 |
157 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
293 |
220 |
$21K |
| D1351 |
Sealant - per tooth |
435 |
136 |
$17K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,530 |
825 |
$14K |
| D7230 |
|
67 |
39 |
$12K |
| D9310 |
|
430 |
421 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
113 |
65 |
$7K |
| D2950 |
|
163 |
67 |
$6K |
| D7250 |
|
19 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
75 |
73 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
13 |
$2K |