| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
470 |
431 |
$22K |
| D0140 |
Limited oral evaluation - problem focused |
542 |
494 |
$16K |
| D1206 |
Topical application of fluoride varnish |
226 |
204 |
$6K |
| D1120 |
Prophylaxis - child |
165 |
143 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
530 |
482 |
$5K |
| D0274 |
Bitewings - four radiographic images |
244 |
229 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
193 |
174 |
$4K |
| D7140 |
Extraction, erupted tooth or exposed root |
75 |
27 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
75 |
25 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
395 |
338 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
157 |
151 |
$2K |
| D4341 |
|
37 |
13 |
$2K |
| D0330 |
Panoramic radiographic image |
54 |
50 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
44 |
12 |
$1K |
| D1351 |
Sealant - per tooth |
60 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
12 |
12 |
$355.00 |
| D1999 |
|
273 |
215 |
$0.00 |
| D9430 |
|
12 |
12 |
$0.00 |