| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,634 |
1,539 |
$64K |
| D1110 |
Prophylaxis - adult |
1,207 |
1,148 |
$48K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,822 |
1,697 |
$39K |
| D1120 |
Prophylaxis - child |
410 |
401 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
601 |
593 |
$15K |
| D2335 |
|
194 |
100 |
$13K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
191 |
142 |
$11K |
| D0274 |
Bitewings - four radiographic images |
438 |
414 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
200 |
128 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
363 |
327 |
$9K |
| D1351 |
Sealant - per tooth |
642 |
168 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
192 |
97 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
563 |
544 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
459 |
417 |
$4K |
| D0272 |
Bitewings - two radiographic images |
103 |
98 |
$2K |
| D9110 |
|
39 |
35 |
$764.61 |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
12 |
12 |
$693.00 |
| D2394 |
|
17 |
12 |
$440.88 |