| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,160 |
2,119 |
$152K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,793 |
2,747 |
$121K |
| D1110 |
Prophylaxis - adult |
1,811 |
1,780 |
$107K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,092 |
651 |
$100K |
| D0274 |
Bitewings - four radiographic images |
2,255 |
2,206 |
$86K |
| D1206 |
Topical application of fluoride varnish |
2,041 |
2,010 |
$62K |
| D0220 |
Intraoral - periapical first radiographic image |
2,960 |
2,831 |
$49K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,952 |
2,075 |
$49K |
| D1120 |
Prophylaxis - child |
1,153 |
1,126 |
$47K |
| D4341 |
|
220 |
86 |
$45K |
| D0120 |
Periodic oral evaluation - established patient |
1,211 |
1,173 |
$42K |
| D0140 |
Limited oral evaluation - problem focused |
995 |
956 |
$40K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
237 |
171 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
313 |
210 |
$23K |
| D1330 |
|
740 |
719 |
$20K |
| D0272 |
Bitewings - two radiographic images |
461 |
459 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
98 |
71 |
$10K |
| D1351 |
Sealant - per tooth |
227 |
45 |
$8K |
| D1354 |
|
264 |
64 |
$8K |
| D2740 |
Crown - porcelain/ceramic |
14 |
12 |
$6K |
| D4910 |
|
69 |
66 |
$5K |
| D2950 |
|
17 |
13 |
$3K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
23 |
14 |
$3K |
| D0270 |
|
149 |
139 |
$2K |
| D9986 |
|
15 |
13 |
$0.00 |