| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
680 |
649 |
$21K |
| D1206 |
Topical application of fluoride varnish |
472 |
455 |
$15K |
| D0210 |
Intraoral - complete series of radiographic images |
287 |
266 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,159 |
1,114 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
166 |
93 |
$9K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
279 |
263 |
$8K |
| D1120 |
Prophylaxis - child |
164 |
164 |
$7K |
| D0274 |
Bitewings - four radiographic images |
290 |
280 |
$6K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,097 |
738 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
305 |
293 |
$5K |
| D0330 |
Panoramic radiographic image |
94 |
92 |
$4K |
| D1351 |
Sealant - per tooth |
162 |
26 |
$3K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
36 |
13 |
$2K |
| D0270 |
|
146 |
142 |
$1K |
| D4346 |
|
12 |
12 |
$733.05 |
| D1110 |
Prophylaxis - adult |
14 |
13 |
$389.60 |
| D1999 |
|
335 |
288 |
$0.00 |
| D9430 |
|
15 |
13 |
$0.00 |