| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
739 |
684 |
$25K |
| D0120 |
Periodic oral evaluation - established patient |
711 |
673 |
$17K |
| D2394 |
|
111 |
82 |
$16K |
| D1110 |
Prophylaxis - adult |
462 |
438 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,173 |
1,028 |
$16K |
| D0230 |
Intraoral - periapical each additional radiographic image |
844 |
486 |
$9K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
67 |
28 |
$7K |
| D1206 |
Topical application of fluoride varnish |
261 |
253 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
28 |
13 |
$3K |
| D0274 |
Bitewings - four radiographic images |
91 |
87 |
$2K |
| D1120 |
Prophylaxis - child |
57 |
56 |
$1K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
26 |
26 |
$1K |
| D0330 |
Panoramic radiographic image |
13 |
12 |
$619.50 |