| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,807 |
2,643 |
$139K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,023 |
1,250 |
$116K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,639 |
1,070 |
$110K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,465 |
3,257 |
$99K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,624 |
605 |
$96K |
| D0274 |
Bitewings - four radiographic images |
4,366 |
4,096 |
$91K |
| D2394 |
|
1,165 |
808 |
$88K |
| D1110 |
Prophylaxis - adult |
2,157 |
2,047 |
$75K |
| D0120 |
Periodic oral evaluation - established patient |
3,439 |
3,273 |
$62K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
847 |
504 |
$45K |
| D2335 |
|
425 |
212 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,557 |
1,413 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,436 |
2,174 |
$35K |
| D0220 |
Intraoral - periapical first radiographic image |
5,239 |
4,759 |
$28K |
| D0350 |
|
2,152 |
548 |
$20K |
| D0180 |
|
762 |
724 |
$20K |
| D2161 |
|
163 |
85 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
804 |
782 |
$13K |
| D2160 |
|
168 |
101 |
$12K |
| D2332 |
|
144 |
80 |
$9K |
| D1120 |
Prophylaxis - child |
400 |
386 |
$8K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
108 |
59 |
$6K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
13 |
13 |
$5K |
| D0210 |
Intraoral - complete series of radiographic images |
67 |
67 |
$4K |
| D2140 |
|
87 |
52 |
$4K |
| D1320 |
|
157 |
154 |
$2K |
| D0272 |
Bitewings - two radiographic images |
149 |
142 |
$2K |
| D2331 |
|
23 |
12 |
$1K |
| D2330 |
|
17 |
12 |
$948.47 |