| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,489 |
1,421 |
$21K |
| D1120 |
Prophylaxis - child |
1,262 |
1,232 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
418 |
230 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
479 |
471 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,773 |
1,665 |
$6K |
| D8670 |
Periodic orthodontic treatment visit |
130 |
115 |
$6K |
| D1206 |
Topical application of fluoride varnish |
417 |
411 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
425 |
415 |
$4K |
| D1110 |
Prophylaxis - adult |
242 |
235 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
172 |
167 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
941 |
383 |
$2K |
| D0274 |
Bitewings - four radiographic images |
262 |
255 |
$2K |
| D0330 |
Panoramic radiographic image |
100 |
100 |
$1K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
16 |
12 |
$570.00 |
| D0210 |
Intraoral - complete series of radiographic images |
13 |
13 |
$338.00 |
| D0240 |
|
120 |
39 |
$295.00 |
| D9310 |
|
19 |
19 |
$285.00 |
| D0340 |
|
17 |
17 |
$240.00 |
| D0270 |
|
26 |
26 |
$75.00 |
| D0350 |
|
18 |
18 |
$18.00 |