| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,779 |
3,590 |
$160K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,149 |
1,127 |
$130K |
| D1110 |
Prophylaxis - adult |
2,849 |
2,747 |
$103K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,565 |
3,403 |
$83K |
| D0120 |
Periodic oral evaluation - established patient |
3,420 |
3,303 |
$64K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,128 |
2,043 |
$37K |
| D1120 |
Prophylaxis - child |
1,060 |
1,019 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
4,197 |
3,998 |
$27K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,623 |
3,468 |
$24K |
| D2140 |
|
181 |
148 |
$8K |
| D2332 |
|
65 |
55 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
97 |
96 |
$4K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
20 |
$2K |
| D2331 |
|
17 |
13 |
$1K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
17 |
15 |
$936.70 |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
12 |
12 |
$685.05 |