| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
819 |
777 |
$15K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
218 |
87 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
129 |
60 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
1,101 |
1,050 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
431 |
426 |
$6K |
| D1110 |
Prophylaxis - adult |
135 |
129 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
49 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
190 |
189 |
$4K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
101 |
100 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
118 |
96 |
$2K |
| D1120 |
Prophylaxis - child |
77 |
77 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
455 |
327 |
$838.05 |
| D0274 |
Bitewings - four radiographic images |
55 |
54 |
$720.81 |
| D0330 |
Panoramic radiographic image |
13 |
13 |
$432.63 |
| D0272 |
Bitewings - two radiographic images |
28 |
28 |
$288.12 |