| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,620 |
1,368 |
$39K |
| D0274 |
Bitewings - four radiographic images |
1,805 |
1,543 |
$32K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
944 |
246 |
$31K |
| D0330 |
Panoramic radiographic image |
1,004 |
852 |
$29K |
| D1120 |
Prophylaxis - child |
774 |
693 |
$28K |
| D0220 |
Intraoral - periapical first radiographic image |
2,399 |
2,030 |
$24K |
| D1206 |
Topical application of fluoride varnish |
965 |
852 |
$22K |
| D0230 |
Intraoral - periapical each additional radiographic image |
3,350 |
1,934 |
$16K |
| D0120 |
Periodic oral evaluation - established patient |
650 |
584 |
$12K |
| D1351 |
Sealant - per tooth |
533 |
70 |
$10K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
236 |
84 |
$8K |
| D1110 |
Prophylaxis - adult |
536 |
437 |
$8K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
271 |
244 |
$7K |
| D0999 |
Unspecified diagnostic procedure, by report |
72 |
72 |
$2K |
| D0602 |
|
394 |
368 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
72 |
72 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
23 |
20 |
$1K |
| D0270 |
|
71 |
67 |
$601.29 |
| D9110 |
|
27 |
25 |
$442.00 |
| D1999 |
|
294 |
205 |
$0.00 |
| D0350 |
|
95 |
80 |
$0.00 |