| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
772 |
662 |
$39K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
309 |
205 |
$36K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
120 |
$20K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
407 |
387 |
$16K |
| D1120 |
Prophylaxis - child |
418 |
388 |
$15K |
| D1351 |
Sealant - per tooth |
478 |
108 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
526 |
487 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
628 |
586 |
$12K |
| D7210 |
Extraction, erupted tooth requiring removal of bone and/or sectioning of tooth |
65 |
44 |
$11K |
| D0120 |
Periodic oral evaluation - established patient |
391 |
362 |
$10K |
| D0274 |
Bitewings - four radiographic images |
401 |
373 |
$10K |
| D1110 |
Prophylaxis - adult |
236 |
225 |
$9K |
| D0210 |
Intraoral - complete series of radiographic images |
139 |
133 |
$7K |
| D0230 |
Intraoral - periapical each additional radiographic image |
345 |
242 |
$5K |
| D4355 |
|
73 |
68 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
52 |
40 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
34 |
29 |
$4K |
| D0272 |
Bitewings - two radiographic images |
70 |
67 |
$1K |
| D0270 |
|
76 |
69 |
$730.01 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
124 |
112 |
$0.00 |
| D4341 |
|
107 |
56 |
$0.00 |