| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
8,243 |
8,197 |
$630K |
| D1110 |
Prophylaxis - adult |
11,788 |
11,725 |
$626K |
| D1206 |
Topical application of fluoride varnish |
18,891 |
18,778 |
$508K |
| D0274 |
Bitewings - four radiographic images |
13,145 |
13,064 |
$474K |
| D0140 |
Limited oral evaluation - problem focused |
12,371 |
11,668 |
$408K |
| D0120 |
Periodic oral evaluation - established patient |
10,746 |
10,696 |
$348K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
8,084 |
8,046 |
$335K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
4,081 |
2,687 |
$322K |
| D1351 |
Sealant - per tooth |
10,952 |
1,885 |
$305K |
| D1120 |
Prophylaxis - child |
8,112 |
8,071 |
$298K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,840 |
1,477 |
$211K |
| D2140 |
|
3,435 |
2,174 |
$204K |
| D7111 |
|
2,074 |
1,200 |
$200K |
| D1330 |
|
6,931 |
6,863 |
$193K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,201 |
1,423 |
$183K |
| D1310 |
|
2,710 |
2,705 |
$131K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,217 |
976 |
$123K |
| D0272 |
Bitewings - two radiographic images |
3,528 |
3,508 |
$115K |
| D0220 |
Intraoral - periapical first radiographic image |
8,551 |
8,062 |
$111K |
| D2160 |
|
943 |
738 |
$92K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,396 |
925 |
$88K |
| D2331 |
|
868 |
594 |
$72K |
| D4355 |
|
1,014 |
1,009 |
$60K |
| D2332 |
|
389 |
285 |
$38K |
| D2335 |
|
315 |
235 |
$31K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,116 |
2,215 |
$31K |
| D2722 |
|
28 |
23 |
$30K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
320 |
269 |
$29K |
| D2330 |
|
432 |
289 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
839 |
832 |
$10K |
| D4341 |
|
31 |
16 |
$7K |
| D7250 |
|
45 |
28 |
$0.00 |
| D9985 |
|
42 |
39 |
$0.00 |
| D0145 |
Oral evaluation for a patient under three years of age |
13 |
13 |
$0.00 |