| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,758 |
2,282 |
$105K |
| D1120 |
Prophylaxis - child |
4,106 |
3,370 |
$102K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,393 |
3,630 |
$92K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,220 |
574 |
$74K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
846 |
396 |
$66K |
| D0274 |
Bitewings - four radiographic images |
3,132 |
2,587 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
4,102 |
3,382 |
$58K |
| D0140 |
Limited oral evaluation - problem focused |
1,529 |
1,339 |
$52K |
| D0120 |
Periodic oral evaluation - established patient |
1,401 |
1,292 |
$36K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,077 |
759 |
$31K |
| D1351 |
Sealant - per tooth |
1,317 |
259 |
$31K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
67 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
44 |
44 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
73 |
62 |
$764.58 |
| D0272 |
Bitewings - two radiographic images |
13 |
12 |
$279.72 |