| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2721 |
|
315 |
212 |
$340K |
| D0330 |
Panoramic radiographic image |
2,284 |
2,263 |
$191K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,128 |
2,109 |
$100K |
| D1110 |
Prophylaxis - adult |
1,427 |
1,417 |
$95K |
| D4341 |
|
410 |
129 |
$92K |
| D0274 |
Bitewings - four radiographic images |
2,016 |
1,999 |
$91K |
| D1206 |
Topical application of fluoride varnish |
2,363 |
2,348 |
$81K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,225 |
2,433 |
$79K |
| D1351 |
Sealant - per tooth |
1,746 |
352 |
$76K |
| D6740 |
|
31 |
14 |
$57K |
| D0220 |
Intraoral - periapical first radiographic image |
3,123 |
3,026 |
$57K |
| D0140 |
Limited oral evaluation - problem focused |
1,346 |
1,312 |
$57K |
| D1330 |
|
1,784 |
1,768 |
$52K |
| D2950 |
|
215 |
145 |
$43K |
| D6245 |
|
23 |
13 |
$43K |
| D0120 |
Periodic oral evaluation - established patient |
1,053 |
1,049 |
$43K |
| D1120 |
Prophylaxis - child |
893 |
891 |
$41K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
281 |
128 |
$30K |
| D0350 |
|
299 |
295 |
$20K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
161 |
92 |
$14K |
| D0272 |
Bitewings - two radiographic images |
332 |
332 |
$12K |
| D4910 |
|
104 |
104 |
$8K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
27 |
16 |
$4K |
| D9985 |
|
25 |
24 |
$0.00 |