| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
4,128 |
2,781 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
909 |
593 |
$76K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,108 |
343 |
$75K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,357 |
2,413 |
$69K |
| D1110 |
Prophylaxis - adult |
1,486 |
1,450 |
$65K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,451 |
2,442 |
$49K |
| D1120 |
Prophylaxis - child |
1,302 |
1,300 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
2,031 |
1,278 |
$29K |
| D7140 |
Extraction, erupted tooth or exposed root |
715 |
202 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,343 |
1,328 |
$25K |
| D0274 |
Bitewings - four radiographic images |
1,019 |
1,003 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
293 |
223 |
$21K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
146 |
112 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
675 |
435 |
$4K |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$342.55 |