| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D7140 |
Extraction, erupted tooth or exposed root |
1,282 |
391 |
$74K |
| D0330 |
Panoramic radiographic image |
851 |
755 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
868 |
646 |
$30K |
| D1120 |
Prophylaxis - child |
618 |
490 |
$22K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
195 |
105 |
$18K |
| D1208 |
Topical application of fluoride, excluding varnish |
962 |
803 |
$18K |
| D1110 |
Prophylaxis - adult |
331 |
306 |
$18K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
496 |
424 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
596 |
489 |
$14K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
116 |
78 |
$11K |
| D0274 |
Bitewings - four radiographic images |
297 |
261 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
161 |
146 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
24 |
14 |
$1K |
| D0272 |
Bitewings - two radiographic images |
32 |
26 |
$616.30 |
| D1351 |
Sealant - per tooth |
23 |
12 |
$510.00 |
| D0230 |
Intraoral - periapical each additional radiographic image |
55 |
16 |
$415.00 |
| D1999 |
|
193 |
150 |
$0.00 |