| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,002 |
2,958 |
$179K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,660 |
831 |
$176K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,172 |
3,125 |
$133K |
| D0230 |
Intraoral - periapical each additional radiographic image |
10,414 |
5,109 |
$127K |
| D0274 |
Bitewings - four radiographic images |
3,787 |
3,740 |
$123K |
| D0120 |
Periodic oral evaluation - established patient |
3,574 |
3,527 |
$88K |
| D0220 |
Intraoral - periapical first radiographic image |
5,733 |
5,608 |
$87K |
| D1110 |
Prophylaxis - adult |
2,287 |
2,255 |
$86K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
817 |
279 |
$63K |
| D9110 |
|
1,178 |
1,154 |
$52K |
| D1120 |
Prophylaxis - child |
1,416 |
1,404 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
1,061 |
1,027 |
$37K |
| D4355 |
|
392 |
384 |
$26K |
| D0272 |
Bitewings - two radiographic images |
720 |
712 |
$13K |
| D1351 |
Sealant - per tooth |
439 |
61 |
$11K |