| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,440 |
1,372 |
$65K |
| D0140 |
Limited oral evaluation - problem focused |
1,741 |
1,620 |
$65K |
| D0274 |
Bitewings - four radiographic images |
1,045 |
973 |
$33K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
158 |
53 |
$28K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
818 |
743 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
937 |
895 |
$19K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
687 |
512 |
$17K |
| D2949 |
|
83 |
40 |
$14K |
| D0220 |
Intraoral - periapical first radiographic image |
1,575 |
1,364 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
606 |
560 |
$11K |
| D7140 |
Extraction, erupted tooth or exposed root |
141 |
40 |
$8K |
| D0330 |
Panoramic radiographic image |
116 |
107 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
53 |
13 |
$4K |
| D2931 |
|
15 |
14 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
513 |
316 |
$3K |
| D2160 |
|
45 |
25 |
$2K |
| D1120 |
Prophylaxis - child |
41 |
39 |
$931.50 |
| D9215 |
|
2,600 |
1,953 |
$0.00 |