| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
774 |
767 |
$41K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
868 |
834 |
$25K |
| D1351 |
Sealant - per tooth |
1,129 |
177 |
$23K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
400 |
156 |
$20K |
| D1120 |
Prophylaxis - child |
458 |
431 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,306 |
723 |
$13K |
| D1206 |
Topical application of fluoride varnish |
295 |
280 |
$8K |
| D0220 |
Intraoral - periapical first radiographic image |
614 |
576 |
$7K |
| D0274 |
Bitewings - four radiographic images |
329 |
311 |
$6K |
| D0160 |
|
202 |
181 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
93 |
88 |
$3K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
133 |
114 |
$2K |
| D9999 |
Unspecified adjunctive procedure, by report |
41 |
41 |
$2K |
| D1110 |
Prophylaxis - adult |
83 |
82 |
$2K |
| D7111 |
|
39 |
18 |
$1K |
| D1208 |
Topical application of fluoride, excluding varnish |
104 |
104 |
$1K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
18 |
12 |
$953.25 |
| D0999 |
Unspecified diagnostic procedure, by report |
27 |
27 |
$810.00 |
| D0120 |
Periodic oral evaluation - established patient |
48 |
44 |
$793.50 |
| D0145 |
Oral evaluation for a patient under three years of age |
15 |
15 |
$225.50 |