| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
5,198 |
5,021 |
$248K |
| D1110 |
Prophylaxis - adult |
4,191 |
4,024 |
$195K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,897 |
1,969 |
$164K |
| D0140 |
Limited oral evaluation - problem focused |
4,563 |
4,370 |
$156K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
2,205 |
1,565 |
$135K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,272 |
4,112 |
$120K |
| D0274 |
Bitewings - four radiographic images |
4,600 |
4,452 |
$110K |
| D5130 |
|
199 |
187 |
$105K |
| D4341 |
|
1,294 |
591 |
$104K |
| D5110 |
|
168 |
161 |
$103K |
| D1120 |
Prophylaxis - child |
1,108 |
1,058 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,220 |
2,141 |
$52K |
| D5120 |
|
88 |
86 |
$50K |
| D0220 |
Intraoral - periapical first radiographic image |
4,845 |
4,575 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
737 |
574 |
$31K |
| D0210 |
Intraoral - complete series of radiographic images |
1,856 |
1,111 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,577 |
1,514 |
$24K |
| D5140 |
|
41 |
39 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,764 |
1,925 |
$19K |
| D2332 |
|
242 |
138 |
$16K |
| D2394 |
|
250 |
202 |
$16K |
| D2740 |
Crown - porcelain/ceramic |
30 |
25 |
$14K |
| D2335 |
|
155 |
92 |
$12K |
| D0272 |
Bitewings - two radiographic images |
698 |
675 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
252 |
133 |
$9K |
| D1208 |
Topical application of fluoride, excluding varnish |
635 |
609 |
$9K |
| D4355 |
|
34 |
34 |
$2K |
| D2331 |
|
19 |
14 |
$1K |
| D9986 |
|
16 |
14 |
$0.00 |