| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D1110 |
Prophylaxis - adult |
1,659 |
1,579 |
$63K |
| D0330 |
Panoramic radiographic image |
1,431 |
1,214 |
$55K |
| D0140 |
Limited oral evaluation - problem focused |
2,887 |
2,297 |
$51K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
291 |
141 |
$33K |
| D0274 |
Bitewings - four radiographic images |
1,342 |
1,297 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
3,436 |
2,574 |
$26K |
| D9630 |
|
1,058 |
919 |
$17K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
741 |
503 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
957 |
935 |
$14K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,190 |
465 |
$10K |
| D1208 |
Topical application of fluoride, excluding varnish |
383 |
358 |
$7K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
38 |
24 |
$4K |
| D1206 |
Topical application of fluoride varnish |
203 |
202 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
53 |
42 |
$1K |
| D1120 |
Prophylaxis - child |
30 |
30 |
$1K |
| D9310 |
|
16 |
12 |
$998.28 |
| D1999 |
|
823 |
732 |
$0.00 |