| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,824 |
2,592 |
$103K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
501 |
328 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
1,682 |
1,681 |
$63K |
| D1120 |
Prophylaxis - child |
1,461 |
1,461 |
$49K |
| D0220 |
Intraoral - periapical first radiographic image |
2,232 |
2,118 |
$34K |
| D1110 |
Prophylaxis - adult |
377 |
377 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,504 |
1,057 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,531 |
1,530 |
$16K |
| D0274 |
Bitewings - four radiographic images |
342 |
342 |
$15K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
188 |
124 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
193 |
193 |
$7K |
| D0330 |
Panoramic radiographic image |
97 |
97 |
$7K |
| D1206 |
Topical application of fluoride varnish |
492 |
492 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
40 |
24 |
$2K |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$312.00 |
| D1999 |
|
18 |
18 |
$0.00 |