| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,635 |
1,632 |
$161K |
| D0140 |
Limited oral evaluation - problem focused |
2,615 |
2,536 |
$118K |
| D0120 |
Periodic oral evaluation - established patient |
2,681 |
2,680 |
$110K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
895 |
491 |
$97K |
| D1110 |
Prophylaxis - adult |
1,387 |
1,387 |
$96K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,104 |
2,672 |
$94K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,097 |
580 |
$92K |
| D0274 |
Bitewings - four radiographic images |
1,938 |
1,935 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
744 |
226 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
797 |
406 |
$87K |
| D1206 |
Topical application of fluoride varnish |
2,380 |
2,379 |
$85K |
| D0220 |
Intraoral - periapical first radiographic image |
3,458 |
3,378 |
$64K |
| D1120 |
Prophylaxis - child |
954 |
953 |
$46K |
| D2160 |
|
304 |
234 |
$40K |
| D2140 |
|
416 |
256 |
$35K |
| D2331 |
|
256 |
168 |
$32K |
| D2332 |
|
147 |
96 |
$23K |
| D2330 |
|
242 |
128 |
$22K |
| D0272 |
Bitewings - two radiographic images |
231 |
231 |
$10K |
| D0240 |
|
204 |
102 |
$9K |
| D2335 |
|
55 |
39 |
$8K |
| D4341 |
|
27 |
12 |
$6K |
| D1351 |
Sealant - per tooth |
117 |
31 |
$5K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
38 |
26 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
31 |
16 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
39 |
39 |
$2K |