| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
1,558 |
1,511 |
$86K |
| D0140 |
Limited oral evaluation - problem focused |
2,482 |
2,389 |
$79K |
| D1120 |
Prophylaxis - child |
799 |
766 |
$40K |
| D1351 |
Sealant - per tooth |
1,551 |
224 |
$32K |
| D0230 |
Intraoral - periapical each additional radiographic image |
4,331 |
1,616 |
$31K |
| D0220 |
Intraoral - periapical first radiographic image |
1,457 |
1,401 |
$24K |
| D0274 |
Bitewings - four radiographic images |
998 |
963 |
$22K |
| D0120 |
Periodic oral evaluation - established patient |
904 |
869 |
$21K |
| D1110 |
Prophylaxis - adult |
587 |
566 |
$11K |
| D4355 |
|
246 |
224 |
$10K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
331 |
320 |
$9K |
| D9994 |
|
958 |
917 |
$8K |
| D1206 |
Topical application of fluoride varnish |
209 |
202 |
$7K |
| D1208 |
Topical application of fluoride, excluding varnish |
417 |
401 |
$4K |
| D0999 |
Unspecified diagnostic procedure, by report |
58 |
58 |
$2K |
| D2940 |
|
52 |
12 |
$1K |
| D9999 |
Unspecified adjunctive procedure, by report |
46 |
46 |
$920.00 |
| D5422 |
|
14 |
12 |
$491.88 |
| D0272 |
Bitewings - two radiographic images |
12 |
12 |
$254.52 |
| D1999 |
|
15 |
15 |
$225.00 |
| D0601 |
|
41 |
41 |
$195.00 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
13 |
12 |
$0.00 |