| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,259 |
1,778 |
$61K |
| D0274 |
Bitewings - four radiographic images |
3,049 |
2,793 |
$59K |
| D1110 |
Prophylaxis - adult |
2,015 |
1,912 |
$55K |
| D0120 |
Periodic oral evaluation - established patient |
2,319 |
2,222 |
$54K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,354 |
1,306 |
$51K |
| D1206 |
Topical application of fluoride varnish |
2,410 |
2,394 |
$33K |
| D9310 |
|
1,005 |
763 |
$31K |
| D1120 |
Prophylaxis - child |
1,358 |
1,353 |
$30K |
| D1351 |
Sealant - per tooth |
1,446 |
278 |
$28K |
| D0140 |
Limited oral evaluation - problem focused |
1,001 |
935 |
$22K |
| D4355 |
|
341 |
290 |
$17K |
| D0350 |
|
750 |
745 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
33 |
24 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
23 |
15 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
134 |
125 |
$1K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$830.09 |