| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,290 |
2,150 |
$70K |
| D0330 |
Panoramic radiographic image |
1,961 |
1,844 |
$67K |
| D0274 |
Bitewings - four radiographic images |
2,115 |
1,993 |
$46K |
| D0220 |
Intraoral - periapical first radiographic image |
3,873 |
3,508 |
$45K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,854 |
3,332 |
$44K |
| D1120 |
Prophylaxis - child |
1,081 |
1,009 |
$44K |
| D0120 |
Periodic oral evaluation - established patient |
1,722 |
1,639 |
$34K |
| D1206 |
Topical application of fluoride varnish |
795 |
758 |
$25K |
| D1110 |
Prophylaxis - adult |
698 |
651 |
$13K |
| D1351 |
Sealant - per tooth |
511 |
46 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
107 |
41 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
155 |
139 |
$4K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
41 |
24 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
30 |
29 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
96 |
87 |
$839.68 |
| D1999 |
|
14 |
14 |
$210.00 |