| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,262 |
1,119 |
$50K |
| D1120 |
Prophylaxis - child |
1,717 |
1,546 |
$38K |
| D0140 |
Limited oral evaluation - problem focused |
921 |
826 |
$28K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
267 |
116 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
750 |
685 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
643 |
562 |
$16K |
| D1206 |
Topical application of fluoride varnish |
638 |
592 |
$14K |
| D1208 |
Topical application of fluoride, excluding varnish |
783 |
691 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
68 |
32 |
$7K |
| D0274 |
Bitewings - four radiographic images |
250 |
221 |
$5K |
| D1351 |
Sealant - per tooth |
110 |
15 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
21 |
14 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
147 |
126 |
$1K |