| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,961 |
3,821 |
$207K |
| D1110 |
Prophylaxis - adult |
2,483 |
2,365 |
$113K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,523 |
2,401 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
3,704 |
3,579 |
$96K |
| D1120 |
Prophylaxis - child |
1,862 |
1,844 |
$66K |
| D0272 |
Bitewings - two radiographic images |
1,700 |
1,621 |
$34K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,643 |
1,616 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
398 |
184 |
$24K |
| D1206 |
Topical application of fluoride varnish |
441 |
439 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
114 |
58 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
189 |
179 |
$4K |
| D0274 |
Bitewings - four radiographic images |
43 |
43 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
35 |
27 |
$361.43 |