| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
4,532 |
4,450 |
$188K |
| D1110 |
Prophylaxis - adult |
3,620 |
3,558 |
$151K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,021 |
4,957 |
$139K |
| D1120 |
Prophylaxis - child |
2,482 |
2,463 |
$123K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,818 |
958 |
$101K |
| D0274 |
Bitewings - four radiographic images |
4,504 |
4,415 |
$95K |
| D0140 |
Limited oral evaluation - problem focused |
2,331 |
2,250 |
$74K |
| D1206 |
Topical application of fluoride varnish |
3,605 |
3,569 |
$54K |
| D0120 |
Periodic oral evaluation - established patient |
2,176 |
2,139 |
$40K |
| D2160 |
|
607 |
399 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
860 |
485 |
$37K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
335 |
277 |
$31K |
| D2140 |
|
630 |
374 |
$27K |
| D0220 |
Intraoral - periapical first radiographic image |
3,789 |
3,661 |
$22K |
| D4341 |
|
263 |
110 |
$20K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
296 |
204 |
$17K |
| D0272 |
Bitewings - two radiographic images |
952 |
944 |
$16K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
198 |
119 |
$9K |
| D2161 |
|
107 |
60 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,649 |
994 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
17 |
12 |
$983.16 |
| D1351 |
Sealant - per tooth |
50 |
12 |
$942.08 |