| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
3,035 |
2,389 |
$83K |
| D0330 |
Panoramic radiographic image |
1,230 |
1,073 |
$42K |
| D0274 |
Bitewings - four radiographic images |
1,822 |
1,590 |
$37K |
| D1120 |
Prophylaxis - child |
879 |
760 |
$33K |
| D1206 |
Topical application of fluoride varnish |
771 |
675 |
$23K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,612 |
1,785 |
$23K |
| D0240 |
|
1,520 |
672 |
$18K |
| D0220 |
Intraoral - periapical first radiographic image |
1,528 |
1,332 |
$18K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
368 |
127 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
618 |
544 |
$16K |
| D1110 |
Prophylaxis - adult |
635 |
582 |
$11K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
181 |
32 |
$9K |
| D0160 |
|
296 |
270 |
$6K |
| D1351 |
Sealant - per tooth |
369 |
56 |
$6K |
| D7311 |
|
152 |
58 |
$4K |
| D4355 |
|
139 |
87 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
32 |
14 |
$2K |
| D0350 |
|
156 |
124 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
47 |
44 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
23 |
23 |
$235.52 |
| D9212 |
|
60 |
32 |
$215.25 |
| D9215 |
|
66 |
42 |
$6.15 |
| D1999 |
|
243 |
168 |
$0.00 |
| 00140 |
|
20 |
20 |
$0.00 |