| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,256 |
2,244 |
$145K |
| D1110 |
Prophylaxis - adult |
2,719 |
2,709 |
$131K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,695 |
2,687 |
$89K |
| D1206 |
Topical application of fluoride varnish |
3,307 |
3,294 |
$82K |
| D0274 |
Bitewings - four radiographic images |
2,322 |
2,315 |
$76K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
613 |
338 |
$75K |
| D0140 |
Limited oral evaluation - problem focused |
1,717 |
1,681 |
$59K |
| D0120 |
Periodic oral evaluation - established patient |
1,624 |
1,614 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
3,403 |
3,226 |
$45K |
| D1120 |
Prophylaxis - child |
938 |
935 |
$34K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,697 |
2,014 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
176 |
117 |
$15K |
| D2722 |
|
17 |
16 |
$15K |
| D0272 |
Bitewings - two radiographic images |
210 |
210 |
$6K |
| D7250 |
|
29 |
13 |
$5K |
| D1330 |
|
181 |
181 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
30 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
147 |
147 |
$2K |
| D1351 |
Sealant - per tooth |
48 |
12 |
$880.00 |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
16 |
12 |
$856.64 |
| D1310 |
|
195 |
194 |
$394.33 |
| D0270 |
|
16 |
16 |
$127.99 |