| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
3,099 |
2,328 |
$153K |
| D1110 |
Prophylaxis - adult |
3,180 |
2,368 |
$135K |
| D1208 |
Topical application of fluoride, excluding varnish |
5,501 |
4,254 |
$110K |
| D0120 |
Periodic oral evaluation - established patient |
4,819 |
3,641 |
$108K |
| D1120 |
Prophylaxis - child |
3,544 |
2,745 |
$107K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,235 |
597 |
$105K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
799 |
367 |
$85K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,727 |
1,308 |
$51K |
| D0272 |
Bitewings - two radiographic images |
2,314 |
1,764 |
$51K |
| D2140 |
|
705 |
401 |
$44K |
| D0140 |
Limited oral evaluation - problem focused |
1,294 |
955 |
$41K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
490 |
338 |
$36K |
| D0274 |
Bitewings - four radiographic images |
792 |
535 |
$25K |
| D7140 |
Extraction, erupted tooth or exposed root |
197 |
113 |
$12K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
31 |
15 |
$4K |
| D1206 |
Topical application of fluoride varnish |
230 |
168 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
133 |
87 |
$2K |