| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,185 |
1,179 |
$63K |
| D1110 |
Prophylaxis - adult |
1,448 |
1,436 |
$58K |
| D1206 |
Topical application of fluoride varnish |
2,008 |
1,998 |
$44K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
663 |
429 |
$41K |
| D0140 |
Limited oral evaluation - problem focused |
1,495 |
1,430 |
$40K |
| D0274 |
Bitewings - four radiographic images |
1,499 |
1,489 |
$40K |
| D0120 |
Periodic oral evaluation - established patient |
1,543 |
1,535 |
$37K |
| D7140 |
Extraction, erupted tooth or exposed root |
455 |
292 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,122 |
1,118 |
$30K |
| D1120 |
Prophylaxis - child |
927 |
925 |
$26K |
| D0272 |
Bitewings - two radiographic images |
595 |
593 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,051 |
1,018 |
$11K |
| D2140 |
|
232 |
149 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
130 |
73 |
$8K |
| T1013 |
Sign language or oral interpretive services, per 15 minutes |
161 |
149 |
$7K |
| D2160 |
|
41 |
37 |
$4K |
| D4355 |
|
42 |
42 |
$2K |
| D1351 |
Sealant - per tooth |
48 |
13 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
16 |
13 |
$928.59 |
| D0270 |
|
53 |
53 |
$401.61 |
| D0230 |
Intraoral - periapical each additional radiographic image |
15 |
12 |
$143.25 |
| D2331 |
|
16 |
12 |
$107.34 |
| D9995 |
|
16 |
15 |
$0.00 |