| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
651 |
563 |
$17K |
| D0330 |
Panoramic radiographic image |
401 |
360 |
$17K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
160 |
93 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
509 |
465 |
$9K |
| D1110 |
Prophylaxis - adult |
201 |
188 |
$9K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
84 |
43 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
514 |
477 |
$8K |
| D2394 |
|
58 |
31 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
634 |
538 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
47 |
$6K |
| D0274 |
Bitewings - four radiographic images |
191 |
170 |
$6K |
| D1120 |
Prophylaxis - child |
189 |
174 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
69 |
25 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
71 |
64 |
$2K |
| D9630 |
|
194 |
180 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
58 |
46 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
219 |
100 |
$2K |
| D0350 |
|
14 |
14 |
$20.00 |
| D1330 |
|
127 |
116 |
$0.00 |
| D1310 |
|
67 |
62 |
$0.00 |