| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,118 |
3,051 |
$368K |
| D4341 |
|
1,978 |
815 |
$273K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,114 |
837 |
$152K |
| D0210 |
Intraoral - complete series of radiographic images |
1,467 |
1,449 |
$138K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,420 |
4,326 |
$136K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
2,784 |
781 |
$134K |
| D2335 |
|
855 |
217 |
$85K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
611 |
333 |
$65K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
287 |
70 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,100 |
1,048 |
$41K |
| D4342 |
|
262 |
117 |
$30K |
| D7250 |
|
79 |
13 |
$21K |
| D2332 |
|
254 |
109 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
322 |
320 |
$10K |
| D5110 |
|
13 |
13 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
550 |
446 |
$4K |
| D1110 |
Prophylaxis - adult |
54 |
54 |
$3K |
| D1330 |
|
122 |
121 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
595 |
567 |
$549.75 |
| D0274 |
Bitewings - four radiographic images |
128 |
128 |
$423.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
99 |
98 |
$328.00 |
| D9986 |
|
40 |
40 |
$0.00 |
| D2330 |
|
17 |
12 |
$0.00 |