| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
2,217 |
1,885 |
$74K |
| D1120 |
Prophylaxis - child |
1,924 |
1,499 |
$44K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
485 |
138 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,117 |
764 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,510 |
1,137 |
$27K |
| D0210 |
Intraoral - complete series of radiographic images |
487 |
366 |
$23K |
| D0330 |
Panoramic radiographic image |
456 |
410 |
$22K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
235 |
120 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
1,428 |
1,244 |
$16K |
| D0274 |
Bitewings - four radiographic images |
738 |
537 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
377 |
339 |
$10K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
22 |
13 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
56 |
36 |
$670.14 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
21 |
17 |
$610.26 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$225.44 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$220.32 |