| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,068 |
2,020 |
$207K |
| D1110 |
Prophylaxis - adult |
3,224 |
3,132 |
$116K |
| D0120 |
Periodic oral evaluation - established patient |
4,231 |
4,098 |
$99K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,908 |
1,872 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
635 |
612 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,037 |
988 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
261 |
160 |
$9K |
| D1351 |
Sealant - per tooth |
11,651 |
2,292 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
304 |
148 |
$8K |
| D2950 |
|
23 |
16 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
139 |
75 |
$3K |
| D1120 |
Prophylaxis - child |
2,768 |
2,701 |
$2K |
| D1330 |
|
6,018 |
5,860 |
$1K |
| D1999 |
|
15 |
15 |
$600.00 |
| D0272 |
Bitewings - two radiographic images |
3,144 |
3,080 |
$238.35 |
| D1208 |
Topical application of fluoride, excluding varnish |
5,650 |
5,497 |
$163.81 |
| D0274 |
Bitewings - four radiographic images |
1,440 |
1,390 |
$72.35 |
| D0220 |
Intraoral - periapical first radiographic image |
991 |
954 |
$41.89 |