| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,822 |
1,658 |
$75K |
| D1120 |
Prophylaxis - child |
1,991 |
1,776 |
$57K |
| D1206 |
Topical application of fluoride varnish |
1,508 |
1,379 |
$36K |
| D0274 |
Bitewings - four radiographic images |
519 |
485 |
$15K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
313 |
292 |
$13K |
| D0330 |
Panoramic radiographic image |
198 |
183 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
67 |
40 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
454 |
403 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
40 |
12 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
102 |
61 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
59 |
50 |
$1K |
| D0272 |
Bitewings - two radiographic images |
13 |
13 |
$321.62 |