| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
4,194 |
3,591 |
$128K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
884 |
386 |
$87K |
| D1120 |
Prophylaxis - child |
3,472 |
2,985 |
$81K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
960 |
425 |
$79K |
| D0120 |
Periodic oral evaluation - established patient |
2,571 |
2,215 |
$57K |
| D1206 |
Topical application of fluoride varnish |
2,353 |
2,040 |
$45K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
585 |
260 |
$45K |
| D0274 |
Bitewings - four radiographic images |
1,637 |
1,371 |
$38K |
| D0220 |
Intraoral - periapical first radiographic image |
3,725 |
2,893 |
$36K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,516 |
771 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
215 |
114 |
$12K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
994 |
778 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
274 |
230 |
$9K |
| D3330 |
Endodontic therapy, molar tooth (excluding final restoration) |
17 |
12 |
$4K |
| D0330 |
Panoramic radiographic image |
119 |
97 |
$4K |
| D2394 |
|
49 |
26 |
$4K |
| D1208 |
Topical application of fluoride, excluding varnish |
120 |
112 |
$2K |
| D0272 |
Bitewings - two radiographic images |
15 |
12 |
$243.50 |