| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
7,578 |
6,775 |
$195K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
1,715 |
1,069 |
$134K |
| D1206 |
Topical application of fluoride varnish |
5,594 |
5,189 |
$96K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,559 |
961 |
$96K |
| D0330 |
Panoramic radiographic image |
2,036 |
1,915 |
$77K |
| D1110 |
Prophylaxis - adult |
1,772 |
1,704 |
$76K |
| D1351 |
Sealant - per tooth |
2,480 |
565 |
$61K |
| D0220 |
Intraoral - periapical first radiographic image |
6,101 |
5,431 |
$57K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,866 |
1,619 |
$46K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
815 |
513 |
$42K |
| D0274 |
Bitewings - four radiographic images |
2,013 |
1,947 |
$40K |
| D0230 |
Intraoral - periapical each additional radiographic image |
5,936 |
3,304 |
$27K |
| D1120 |
Prophylaxis - child |
807 |
769 |
$22K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
267 |
184 |
$19K |
| D1999 |
|
792 |
682 |
$8K |
| D9110 |
|
128 |
124 |
$7K |
| D7250 |
|
29 |
12 |
$3K |
| D0272 |
Bitewings - two radiographic images |
258 |
246 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
35 |
12 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
85 |
83 |
$1K |
| D0240 |
|
104 |
51 |
$986.62 |
| D0120 |
Periodic oral evaluation - established patient |
36 |
34 |
$796.00 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
14 |
$422.52 |