| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,200 |
2,098 |
$131K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
448 |
233 |
$71K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,830 |
1,729 |
$46K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,553 |
2,409 |
$41K |
| D1110 |
Prophylaxis - adult |
1,202 |
1,129 |
$39K |
| D9110 |
|
639 |
607 |
$34K |
| D0140 |
Limited oral evaluation - problem focused |
992 |
933 |
$33K |
| D0210 |
Intraoral - complete series of radiographic images |
519 |
477 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
439 |
155 |
$25K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
272 |
128 |
$21K |
| D4346 |
|
217 |
208 |
$21K |
| D0274 |
Bitewings - four radiographic images |
849 |
799 |
$20K |
| D4355 |
|
249 |
237 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
852 |
805 |
$17K |
| D1120 |
Prophylaxis - child |
519 |
503 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
271 |
264 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
118 |
114 |
$1K |