| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
739 |
582 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,387 |
279 |
$7K |
| D0330 |
Panoramic radiographic image |
289 |
226 |
$2K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
23 |
14 |
$777.75 |
| D1354 |
|
1,548 |
247 |
$260.73 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
121 |
112 |
$229.50 |
| D2941 |
|
171 |
67 |
$117.52 |
| D0150 |
Comprehensive oral evaluation - new or established patient |
160 |
150 |
$77.30 |
| D1206 |
Topical application of fluoride varnish |
282 |
252 |
$27.24 |
| D0240 |
|
47 |
26 |
$8.72 |
| D0230 |
Intraoral - periapical each additional radiographic image |
27 |
13 |
$0.00 |
| D1351 |
Sealant - per tooth |
123 |
41 |
$0.00 |
| D1310 |
|
131 |
124 |
$0.00 |
| D0603 |
|
137 |
128 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
42 |
42 |
$0.00 |
| D1330 |
|
134 |
127 |
$0.00 |
| D0120 |
Periodic oral evaluation - established patient |
13 |
13 |
$0.00 |
| D0220 |
Intraoral - periapical first radiographic image |
28 |
28 |
$0.00 |
| D1120 |
Prophylaxis - child |
59 |
57 |
$0.00 |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
41 |
15 |
$0.00 |