| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,760 |
3,697 |
$292K |
| D1110 |
Prophylaxis - adult |
4,144 |
4,093 |
$265K |
| D0230 |
Intraoral - periapical each additional radiographic image |
12,305 |
4,654 |
$163K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,509 |
3,467 |
$161K |
| D0274 |
Bitewings - four radiographic images |
3,732 |
3,687 |
$157K |
| D1206 |
Topical application of fluoride varnish |
4,578 |
4,552 |
$153K |
| D0120 |
Periodic oral evaluation - established patient |
3,624 |
3,590 |
$140K |
| D0220 |
Intraoral - periapical first radiographic image |
5,934 |
5,788 |
$109K |
| D1330 |
|
5,138 |
5,021 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
965 |
643 |
$98K |
| D1120 |
Prophylaxis - child |
2,145 |
2,134 |
$96K |
| D0140 |
Limited oral evaluation - problem focused |
2,156 |
2,107 |
$88K |
| D7140 |
Extraction, erupted tooth or exposed root |
741 |
487 |
$73K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
541 |
291 |
$44K |
| D0272 |
Bitewings - two radiographic images |
651 |
647 |
$24K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
82 |
63 |
$9K |
| D0270 |
|
659 |
644 |
$9K |
| D4341 |
|
37 |
12 |
$8K |
| D1351 |
Sealant - per tooth |
190 |
45 |
$7K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
35 |
33 |
$5K |
| D4910 |
|
24 |
24 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
15 |
12 |
$2K |
| D9430 |
|
39 |
34 |
$1K |