| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0330 |
Panoramic radiographic image |
507 |
502 |
$88K |
| D1120 |
Prophylaxis - child |
1,522 |
1,512 |
$80K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
833 |
828 |
$46K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
141 |
108 |
$37K |
| D1110 |
Prophylaxis - adult |
490 |
488 |
$36K |
| D1351 |
Sealant - per tooth |
994 |
253 |
$18K |
| D0210 |
Intraoral - complete series of radiographic images |
78 |
78 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
121 |
87 |
$13K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
44 |
39 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
209 |
208 |
$7K |
| D2332 |
|
17 |
12 |
$4K |
| D0274 |
Bitewings - four radiographic images |
199 |
199 |
$3K |
| D9999 |
Unspecified adjunctive procedure, by report |
51 |
51 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
677 |
638 |
$793.53 |
| D1330 |
|
1,317 |
1,308 |
$513.79 |
| D0120 |
Periodic oral evaluation - established patient |
1,183 |
1,176 |
$300.91 |
| D0272 |
Bitewings - two radiographic images |
470 |
469 |
$17.39 |
| D9986 |
|
12 |
12 |
$0.00 |
| D1208 |
Topical application of fluoride, excluding varnish |
1,991 |
1,979 |
$0.00 |