| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
973 |
938 |
$95K |
| D7140 |
Extraction, erupted tooth or exposed root |
785 |
386 |
$87K |
| D1206 |
Topical application of fluoride varnish |
2,129 |
2,053 |
$87K |
| D1120 |
Prophylaxis - child |
1,576 |
1,519 |
$79K |
| D1110 |
Prophylaxis - adult |
678 |
652 |
$52K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
815 |
790 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,171 |
1,116 |
$46K |
| D0272 |
Bitewings - two radiographic images |
1,303 |
1,268 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
578 |
532 |
$38K |
| D1351 |
Sealant - per tooth |
348 |
77 |
$14K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
92 |
70 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
292 |
265 |
$7K |
| D2140 |
|
50 |
39 |
$5K |
| D0274 |
Bitewings - four radiographic images |
87 |
83 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
12 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$348.00 |
| D0210 |
Intraoral - complete series of radiographic images |
15 |
14 |
$263.00 |