| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,015 |
1,907 |
$159K |
| D1110 |
Prophylaxis - adult |
2,155 |
2,086 |
$133K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,281 |
442 |
$133K |
| D1206 |
Topical application of fluoride varnish |
3,381 |
3,266 |
$103K |
| D0274 |
Bitewings - four radiographic images |
2,051 |
1,986 |
$88K |
| D0120 |
Periodic oral evaluation - established patient |
2,157 |
2,142 |
$87K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,979 |
1,865 |
$85K |
| D1120 |
Prophylaxis - child |
1,540 |
1,515 |
$66K |
| D0140 |
Limited oral evaluation - problem focused |
1,508 |
1,360 |
$58K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
299 |
195 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,467 |
1,392 |
$24K |
| D1330 |
|
604 |
594 |
$22K |
| D0272 |
Bitewings - two radiographic images |
589 |
583 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
703 |
600 |
$15K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
96 |
70 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
99 |
72 |
$10K |
| D1354 |
|
338 |
84 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
712 |
330 |
$8K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
65 |
49 |
$5K |
| D2160 |
|
32 |
24 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
21 |
14 |
$3K |
| D2335 |
|
20 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
98 |
26 |
$3K |
| D1999 |
|
1,553 |
1,327 |
$41.10 |