| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,510 |
2,484 |
$117K |
| D1110 |
Prophylaxis - adult |
2,253 |
2,223 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,075 |
3,020 |
$79K |
| D0274 |
Bitewings - four radiographic images |
2,367 |
2,324 |
$62K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,061 |
680 |
$60K |
| D0140 |
Limited oral evaluation - problem focused |
1,637 |
1,519 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,142 |
802 |
$48K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
933 |
736 |
$48K |
| D2332 |
|
689 |
490 |
$44K |
| D1120 |
Prophylaxis - child |
709 |
694 |
$33K |
| D0120 |
Periodic oral evaluation - established patient |
1,106 |
1,093 |
$30K |
| D9110 |
|
534 |
492 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,665 |
1,639 |
$26K |
| D0220 |
Intraoral - periapical first radiographic image |
3,187 |
3,030 |
$25K |
| D2331 |
|
365 |
282 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,838 |
1,643 |
$16K |
| D2335 |
|
214 |
164 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
227 |
190 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
172 |
$10K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
200 |
173 |
$9K |
| D7250 |
|
37 |
15 |
$5K |
| D2330 |
|
94 |
58 |
$4K |
| D2140 |
|
46 |
41 |
$2K |
| D2160 |
|
25 |
24 |
$1K |
| D9996 |
|
27 |
27 |
$1K |