| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,953 |
3,840 |
$156K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,265 |
1,445 |
$101K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,966 |
2,890 |
$69K |
| D1120 |
Prophylaxis - child |
1,549 |
1,518 |
$63K |
| D1110 |
Prophylaxis - adult |
1,406 |
1,367 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,926 |
1,845 |
$55K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
794 |
604 |
$45K |
| D1351 |
Sealant - per tooth |
2,591 |
858 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,961 |
1,932 |
$24K |
| D9110 |
|
397 |
393 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
483 |
348 |
$21K |
| D0274 |
Bitewings - four radiographic images |
588 |
573 |
$14K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
165 |
151 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
376 |
375 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,149 |
1,116 |
$9K |
| D2335 |
|
94 |
66 |
$6K |
| D0272 |
Bitewings - two radiographic images |
308 |
303 |
$5K |
| D2332 |
|
31 |
24 |
$2K |
| D2331 |
|
34 |
24 |
$2K |