| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,084 |
2,295 |
$105K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,030 |
1,531 |
$84K |
| D1110 |
Prophylaxis - adult |
1,802 |
1,507 |
$82K |
| D0330 |
Panoramic radiographic image |
1,162 |
984 |
$61K |
| D0120 |
Periodic oral evaluation - established patient |
2,733 |
2,234 |
$59K |
| D1208 |
Topical application of fluoride, excluding varnish |
3,107 |
2,569 |
$58K |
| D9630 |
|
2,926 |
2,424 |
$58K |
| D1120 |
Prophylaxis - child |
1,684 |
1,412 |
$55K |
| D0274 |
Bitewings - four radiographic images |
1,691 |
1,421 |
$52K |
| D0272 |
Bitewings - two radiographic images |
1,735 |
1,469 |
$37K |
| D1351 |
Sealant - per tooth |
1,226 |
136 |
$36K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
323 |
223 |
$27K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
718 |
655 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
164 |
118 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
179 |
78 |
$9K |
| D0350 |
|
204 |
173 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
98 |
25 |
$2K |
| D1320 |
|
32 |
31 |
$930.00 |
| D0220 |
Intraoral - periapical first radiographic image |
29 |
29 |
$599.00 |