| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
1,363 |
1,063 |
$42K |
| D1120 |
Prophylaxis - child |
1,163 |
967 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,059 |
890 |
$21K |
| D0120 |
Periodic oral evaluation - established patient |
631 |
596 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
87 |
40 |
$9K |
| D0330 |
Panoramic radiographic image |
253 |
187 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
118 |
51 |
$7K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
319 |
172 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
390 |
368 |
$4K |
| D1351 |
Sealant - per tooth |
52 |
12 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
17 |
17 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
96 |
28 |
$742.34 |
| D0274 |
Bitewings - four radiographic images |
29 |
25 |
$659.88 |
| D1208 |
Topical application of fluoride, excluding varnish |
13 |
13 |
$211.31 |