| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,030 |
1,966 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,146 |
3,053 |
$82K |
| D1110 |
Prophylaxis - adult |
1,660 |
1,610 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,401 |
591 |
$63K |
| D0274 |
Bitewings - four radiographic images |
2,099 |
2,042 |
$49K |
| D1120 |
Prophylaxis - child |
632 |
608 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,409 |
1,361 |
$21K |
| D4341 |
|
164 |
40 |
$11K |
| D5110 |
|
14 |
14 |
$9K |
| D5120 |
|
12 |
12 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
126 |
83 |
$7K |
| D2335 |
|
63 |
37 |
$5K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
66 |
37 |
$4K |
| D2332 |
|
18 |
13 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
13 |
12 |
$756.33 |
| D0220 |
Intraoral - periapical first radiographic image |
76 |
69 |
$585.76 |
| D0272 |
Bitewings - two radiographic images |
14 |
12 |
$190.18 |
| D9986 |
|
39 |
28 |
$0.00 |