| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,613 |
1,492 |
$62K |
| D1110 |
Prophylaxis - adult |
1,643 |
1,533 |
$45K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
629 |
212 |
$43K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,098 |
1,974 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,534 |
1,391 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
722 |
665 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,553 |
1,431 |
$20K |
| D0220 |
Intraoral - periapical first radiographic image |
2,002 |
1,844 |
$15K |
| D0274 |
Bitewings - four radiographic images |
925 |
896 |
$14K |
| D1351 |
Sealant - per tooth |
745 |
66 |
$14K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
152 |
99 |
$10K |
| D9110 |
|
487 |
427 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
117 |
72 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
136 |
41 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
245 |
231 |
$3K |
| D2394 |
|
51 |
31 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
507 |
462 |
$3K |
| D0191 |
|
228 |
222 |
$2K |
| D1206 |
Topical application of fluoride varnish |
100 |
92 |
$1K |
| D1120 |
Prophylaxis - child |
32 |
32 |
$840.15 |
| D9910 |
|
17 |
13 |
$263.15 |