| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,736 |
2,517 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
3,276 |
3,187 |
$73K |
| D0230 |
Intraoral - periapical each additional radiographic image |
6,399 |
2,268 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,679 |
1,631 |
$52K |
| D1110 |
Prophylaxis - adult |
1,426 |
1,368 |
$46K |
| D1120 |
Prophylaxis - child |
1,092 |
1,063 |
$45K |
| D0220 |
Intraoral - periapical first radiographic image |
3,782 |
3,127 |
$45K |
| D7971 |
|
88 |
87 |
$32K |
| D7140 |
Extraction, erupted tooth or exposed root |
482 |
204 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,067 |
1,050 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,469 |
1,436 |
$24K |
| D0330 |
Panoramic radiographic image |
659 |
610 |
$16K |
| D2332 |
|
128 |
55 |
$12K |
| D2335 |
|
73 |
38 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
170 |
152 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
132 |
128 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
56 |
12 |
$5K |
| D2940 |
|
95 |
46 |
$4K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
28 |
12 |
$3K |
| D1351 |
Sealant - per tooth |
70 |
17 |
$2K |
| D9310 |
|
13 |
13 |
$210.12 |