| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
2,301 |
2,199 |
$170K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
2,591 |
1,252 |
$87K |
| D1110 |
Prophylaxis - adult |
3,504 |
3,346 |
$73K |
| D0210 |
Intraoral - complete series of radiographic images |
386 |
366 |
$58K |
| D0120 |
Periodic oral evaluation - established patient |
3,145 |
3,001 |
$50K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
367 |
221 |
$39K |
| D1120 |
Prophylaxis - child |
1,669 |
1,594 |
$38K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,570 |
1,646 |
$37K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,268 |
2,179 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,184 |
4,950 |
$7K |
| D1330 |
|
5,223 |
4,989 |
$7K |
| D7111 |
|
116 |
65 |
$6K |
| D1351 |
Sealant - per tooth |
2,798 |
865 |
$6K |
| D4341 |
|
327 |
105 |
$5K |
| D2332 |
|
80 |
54 |
$4K |
| D0274 |
Bitewings - four radiographic images |
3,229 |
3,096 |
$3K |
| D0272 |
Bitewings - two radiographic images |
1,478 |
1,400 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
4,019 |
3,849 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,877 |
3,673 |
$751.40 |
| D9999 |
Unspecified adjunctive procedure, by report |
13 |
13 |
$325.00 |
| D7140 |
Extraction, erupted tooth or exposed root |
22 |
14 |
$124.86 |
| D0602 |
|
173 |
143 |
$0.00 |
| D0603 |
|
415 |
344 |
$0.00 |