| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,294 |
1,214 |
$12K |
| D2740 |
Crown - porcelain/ceramic |
117 |
74 |
$11K |
| D0330 |
Panoramic radiographic image |
624 |
600 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
2,592 |
2,481 |
$7K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
164 |
95 |
$6K |
| D1206 |
Topical application of fluoride varnish |
913 |
905 |
$5K |
| D0274 |
Bitewings - four radiographic images |
604 |
596 |
$4K |
| D2950 |
|
241 |
132 |
$4K |
| D0270 |
|
1,112 |
1,057 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
278 |
275 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,398 |
1,337 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
588 |
582 |
$2K |
| D1120 |
Prophylaxis - child |
403 |
401 |
$2K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
64 |
24 |
$2K |
| D1110 |
Prophylaxis - adult |
165 |
162 |
$2K |
| D0272 |
Bitewings - two radiographic images |
244 |
241 |
$223.86 |
| D1208 |
Topical application of fluoride, excluding varnish |
288 |
286 |
$16.48 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
15 |
14 |
$0.00 |