| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
5,232 |
5,228 |
$130K |
| D7140 |
Extraction, erupted tooth or exposed root |
2,807 |
1,750 |
$120K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
5,540 |
5,533 |
$110K |
| D1110 |
Prophylaxis - adult |
3,935 |
3,930 |
$84K |
| D0120 |
Periodic oral evaluation - established patient |
2,613 |
2,608 |
$59K |
| D2750 |
|
117 |
98 |
$49K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
763 |
562 |
$34K |
| D9110 |
|
1,349 |
1,347 |
$14K |
| D1120 |
Prophylaxis - child |
469 |
469 |
$13K |
| D2950 |
|
189 |
160 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
2,197 |
2,189 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
854 |
853 |
$10K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,428 |
1,425 |
$5K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
12 |
12 |
$5K |
| D5110 |
|
15 |
15 |
$4K |
| D0601 |
|
396 |
396 |
$4K |
| D2335 |
|
14 |
12 |
$792.00 |
| D0140 |
Limited oral evaluation - problem focused |
24 |
24 |
$456.00 |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$432.00 |
| D0272 |
Bitewings - two radiographic images |
26 |
26 |
$182.00 |