| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
5,269 |
5,015 |
$113K |
| D1206 |
Topical application of fluoride varnish |
4,091 |
3,936 |
$69K |
| D0120 |
Periodic oral evaluation - established patient |
2,733 |
2,619 |
$66K |
| D1120 |
Prophylaxis - child |
2,835 |
2,724 |
$57K |
| D8670 |
Periodic orthodontic treatment visit |
113 |
113 |
$33K |
| D0330 |
Panoramic radiographic image |
688 |
666 |
$23K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
470 |
458 |
$16K |
| D8080 |
Comprehensive orthodontic treatment of the adolescent dentition |
26 |
26 |
$14K |
| D7140 |
Extraction, erupted tooth or exposed root |
190 |
50 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
49 |
13 |
$6K |
| D1351 |
Sealant - per tooth |
237 |
60 |
$4K |
| D1110 |
Prophylaxis - adult |
99 |
95 |
$3K |
| D0340 |
|
55 |
50 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
313 |
289 |
$2K |
| D0272 |
Bitewings - two radiographic images |
175 |
157 |
$2K |
| D9992 |
|
101 |
101 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
387 |
105 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
33 |
32 |
$640.00 |
| D2941 |
|
21 |
12 |
$636.10 |
| D1354 |
|
164 |
41 |
$471.00 |