| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
6,146 |
6,099 |
$216K |
| D1110 |
Prophylaxis - adult |
3,860 |
3,860 |
$185K |
| D0330 |
Panoramic radiographic image |
3,461 |
3,461 |
$165K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,663 |
1,158 |
$138K |
| D0220 |
Intraoral - periapical first radiographic image |
10,776 |
10,584 |
$129K |
| D0274 |
Bitewings - four radiographic images |
4,171 |
4,171 |
$105K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,273 |
2,273 |
$87K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
836 |
487 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
1,061 |
1,061 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
202 |
158 |
$21K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
176 |
109 |
$14K |
| D1120 |
Prophylaxis - child |
222 |
222 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
208 |
192 |
$7K |
| D1206 |
Topical application of fluoride varnish |
406 |
406 |
$7K |
| D1351 |
Sealant - per tooth |
141 |
52 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
27 |
24 |
$4K |
| D0272 |
Bitewings - two radiographic images |
175 |
175 |
$3K |
| D0240 |
|
120 |
82 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
190 |
107 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$540.00 |