| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
375 |
373 |
$18K |
| D1206 |
Topical application of fluoride varnish |
483 |
480 |
$13K |
| D1120 |
Prophylaxis - child |
274 |
272 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
89 |
59 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
205 |
205 |
$7K |
| D0330 |
Panoramic radiographic image |
180 |
180 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
492 |
482 |
$5K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
143 |
124 |
$4K |
| D1110 |
Prophylaxis - adult |
78 |
78 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
129 |
128 |
$4K |
| D0274 |
Bitewings - four radiographic images |
200 |
200 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,079 |
370 |
$3K |
| D1351 |
Sealant - per tooth |
84 |
26 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
20 |
17 |
$1K |
| D0272 |
Bitewings - two radiographic images |
114 |
114 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
17 |
12 |
$980.05 |
| D1354 |
|
34 |
12 |
$138.60 |
| T1015 |
Clinic visit/encounter, all-inclusive |
1,288 |
1,036 |
$0.00 |