| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,621 |
1,262 |
$54K |
| D1120 |
Prophylaxis - child |
1,832 |
1,547 |
$47K |
| D1206 |
Topical application of fluoride varnish |
1,575 |
1,315 |
$33K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
841 |
687 |
$26K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
189 |
105 |
$17K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
263 |
120 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
706 |
612 |
$17K |
| D0272 |
Bitewings - two radiographic images |
931 |
735 |
$14K |
| D0330 |
Panoramic radiographic image |
215 |
181 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
551 |
431 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
62 |
27 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
53 |
40 |
$2K |
| D0274 |
Bitewings - four radiographic images |
104 |
93 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
27 |
$720.54 |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$123.02 |