| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,567 |
2,545 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,745 |
2,722 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
3,015 |
2,994 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
912 |
482 |
$49K |
| D1110 |
Prophylaxis - adult |
1,362 |
1,346 |
$46K |
| D1120 |
Prophylaxis - child |
2,224 |
2,211 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,834 |
1,824 |
$27K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
354 |
165 |
$20K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
274 |
184 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
236 |
124 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
539 |
529 |
$12K |
| D1351 |
Sealant - per tooth |
499 |
122 |
$11K |
| D1206 |
Topical application of fluoride varnish |
675 |
670 |
$11K |
| D0274 |
Bitewings - four radiographic images |
532 |
527 |
$11K |
| D2161 |
|
83 |
42 |
$6K |
| D2394 |
|
74 |
46 |
$6K |
| D0272 |
Bitewings - two radiographic images |
531 |
528 |
$5K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
93 |
54 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
551 |
536 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
39 |
27 |
$2K |
| D2160 |
|
16 |
12 |
$1K |
| D0240 |
|
30 |
15 |
$360.00 |