| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,707 |
1,495 |
$60K |
| D1110 |
Prophylaxis - adult |
744 |
712 |
$40K |
| D0330 |
Panoramic radiographic image |
555 |
523 |
$36K |
| D0120 |
Periodic oral evaluation - established patient |
1,041 |
934 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
506 |
427 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
76 |
28 |
$7K |
| D1120 |
Prophylaxis - child |
192 |
162 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
221 |
187 |
$3K |
| D1351 |
Sealant - per tooth |
129 |
13 |
$3K |
| D0274 |
Bitewings - four radiographic images |
72 |
70 |
$3K |
| D9310 |
|
30 |
28 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
32 |
28 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
14 |
13 |
$500.50 |
| D0230 |
Intraoral - periapical each additional radiographic image |
49 |
12 |
$407.00 |
| D0272 |
Bitewings - two radiographic images |
14 |
13 |
$160.00 |