| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,999 |
1,971 |
$93K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,350 |
653 |
$72K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,389 |
2,348 |
$63K |
| D0120 |
Periodic oral evaluation - established patient |
2,615 |
2,589 |
$46K |
| D1120 |
Prophylaxis - child |
2,009 |
1,973 |
$42K |
| D1110 |
Prophylaxis - adult |
1,131 |
1,126 |
$38K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,380 |
1,356 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
769 |
737 |
$17K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
266 |
169 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
308 |
182 |
$16K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
269 |
157 |
$14K |
| D0274 |
Bitewings - four radiographic images |
716 |
712 |
$14K |
| D1206 |
Topical application of fluoride varnish |
785 |
770 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
127 |
53 |
$7K |
| D0272 |
Bitewings - two radiographic images |
505 |
501 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
929 |
916 |
$5K |
| D1351 |
Sealant - per tooth |
194 |
48 |
$4K |
| D2140 |
|
79 |
44 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
46 |
45 |
$3K |
| D9944 |
|
12 |
12 |
$2K |
| D2160 |
|
21 |
14 |
$1K |
| D0240 |
|
106 |
54 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
50 |
48 |
$245.00 |