| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
1,800 |
1,773 |
$73K |
| D1110 |
Prophylaxis - adult |
1,545 |
1,520 |
$53K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,909 |
3,601 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
526 |
395 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
610 |
412 |
$17K |
| D0274 |
Bitewings - four radiographic images |
3,190 |
3,148 |
$17K |
| D0140 |
Limited oral evaluation - problem focused |
1,015 |
975 |
$10K |
| D1330 |
|
1,827 |
1,798 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
175 |
172 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,792 |
1,769 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
1,828 |
1,804 |
$6K |
| D1351 |
Sealant - per tooth |
262 |
89 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
89 |
71 |
$2K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
20 |
14 |
$2K |
| D1206 |
Topical application of fluoride varnish |
1,838 |
1,807 |
$1K |
| D1354 |
|
195 |
37 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
4,523 |
4,410 |
$1K |
| D1120 |
Prophylaxis - child |
72 |
72 |
$95.54 |
| D0272 |
Bitewings - two radiographic images |
107 |
103 |
$93.52 |
| D1310 |
|
1,243 |
1,234 |
$0.00 |
| D0603 |
|
346 |
341 |
$0.00 |