| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
400 |
375 |
$19K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
412 |
391 |
$11K |
| D1351 |
Sealant - per tooth |
415 |
38 |
$9K |
| D1110 |
Prophylaxis - adult |
209 |
196 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
421 |
372 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
166 |
150 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
34 |
15 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
197 |
189 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
47 |
28 |
$3K |
| D1120 |
Prophylaxis - child |
105 |
101 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
54 |
31 |
$3K |
| D1206 |
Topical application of fluoride varnish |
72 |
64 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
83 |
62 |
$502.65 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
12 |
$241.31 |