| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,134 |
2,121 |
$103K |
| D1110 |
Prophylaxis - adult |
1,602 |
1,595 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
767 |
301 |
$45K |
| D1120 |
Prophylaxis - child |
1,604 |
1,594 |
$45K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,725 |
2,711 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,968 |
1,961 |
$35K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
258 |
136 |
$25K |
| D0210 |
Intraoral - complete series of radiographic images |
382 |
382 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,312 |
3,295 |
$7K |
| D0274 |
Bitewings - four radiographic images |
2,174 |
2,164 |
$6K |
| D1351 |
Sealant - per tooth |
2,048 |
533 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
328 |
322 |
$2K |
| D1330 |
|
4,732 |
4,706 |
$2K |
| D7111 |
|
26 |
13 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
2,946 |
2,910 |
$987.85 |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,896 |
2,647 |
$804.45 |
| D0272 |
Bitewings - two radiographic images |
501 |
498 |
$711.26 |
| D0602 |
|
12 |
12 |
$6.00 |
| D0601 |
|
31 |
31 |
$5.00 |
| D0603 |
|
200 |
200 |
$0.00 |
| D1999 |
|
54 |
54 |
$0.00 |
| D4921 |
|
79 |
59 |
$0.00 |