| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
454 |
450 |
$20K |
| D7140 |
Extraction, erupted tooth or exposed root |
327 |
83 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
549 |
540 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
111 |
46 |
$6K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
46 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
186 |
181 |
$4K |
| D1351 |
Sealant - per tooth |
184 |
35 |
$4K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
58 |
26 |
$3K |
| D0274 |
Bitewings - four radiographic images |
396 |
393 |
$3K |
| D1110 |
Prophylaxis - adult |
82 |
82 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
49 |
49 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
117 |
116 |
$2K |
| D7310 |
|
19 |
12 |
$2K |
| D1120 |
Prophylaxis - child |
72 |
71 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
16 |
16 |
$256.20 |
| D0272 |
Bitewings - two radiographic images |
17 |
17 |
$90.00 |