| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
427 |
421 |
$69K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
82 |
81 |
$14K |
| D0330 |
Panoramic radiographic image |
65 |
64 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
13 |
12 |
$1K |
| D1354 |
|
5,165 |
523 |
$784.50 |
| D0220 |
Intraoral - periapical first radiographic image |
219 |
213 |
$663.88 |
| D1351 |
Sealant - per tooth |
279 |
67 |
$645.96 |
| D1330 |
|
633 |
617 |
$572.60 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
37 |
33 |
$124.86 |
| D7140 |
Extraction, erupted tooth or exposed root |
23 |
12 |
$121.88 |
| D0230 |
Intraoral - periapical each additional radiographic image |
221 |
214 |
$31.75 |
| D1208 |
Topical application of fluoride, excluding varnish |
624 |
616 |
$0.00 |
| D0272 |
Bitewings - two radiographic images |
536 |
531 |
$0.00 |
| D0240 |
|
624 |
438 |
$0.00 |
| D1120 |
Prophylaxis - child |
534 |
526 |
$0.00 |
| D1110 |
Prophylaxis - adult |
33 |
33 |
$0.00 |