| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,049 |
3,001 |
$141K |
| D1110 |
Prophylaxis - adult |
2,944 |
2,900 |
$131K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,040 |
1,251 |
$117K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,355 |
3,291 |
$100K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,174 |
696 |
$88K |
| D0274 |
Bitewings - four radiographic images |
3,279 |
3,221 |
$80K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
1,041 |
713 |
$70K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,201 |
427 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,051 |
664 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,115 |
1,085 |
$35K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,308 |
2,072 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,468 |
3,343 |
$28K |
| D4341 |
|
339 |
144 |
$28K |
| D0120 |
Periodic oral evaluation - established patient |
1,403 |
1,398 |
$26K |
| D2331 |
|
189 |
132 |
$11K |
| D2332 |
|
51 |
36 |
$3K |
| D1206 |
Topical application of fluoride varnish |
163 |
155 |
$3K |
| D2335 |
|
38 |
25 |
$3K |
| D2394 |
|
13 |
12 |
$997.80 |