| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,496 |
3,289 |
$142K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,437 |
5,087 |
$134K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,958 |
1,212 |
$123K |
| D1110 |
Prophylaxis - adult |
2,913 |
2,718 |
$119K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,003 |
671 |
$52K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
598 |
389 |
$51K |
| D0140 |
Limited oral evaluation - problem focused |
1,125 |
1,067 |
$37K |
| D1120 |
Prophylaxis - child |
798 |
738 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,924 |
1,773 |
$26K |
| D2331 |
|
489 |
305 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
608 |
356 |
$23K |
| D1351 |
Sealant - per tooth |
802 |
163 |
$15K |
| D0274 |
Bitewings - four radiographic images |
665 |
615 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
284 |
270 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
83 |
71 |
$5K |
| D2332 |
|
64 |
42 |
$4K |
| D0272 |
Bitewings - two radiographic images |
120 |
108 |
$2K |
| D2335 |
|
15 |
13 |
$1K |
| D2330 |
|
25 |
16 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
107 |
107 |
$823.88 |
| D1206 |
Topical application of fluoride varnish |
46 |
46 |
$806.25 |
| D9986 |
|
60 |
42 |
$15.00 |