| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
767 |
722 |
$32K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
138 |
80 |
$16K |
| D1120 |
Prophylaxis - child |
397 |
384 |
$12K |
| D7140 |
Extraction, erupted tooth or exposed root |
139 |
66 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
125 |
125 |
$9K |
| D0274 |
Bitewings - four radiographic images |
251 |
245 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
438 |
400 |
$5K |
| D1206 |
Topical application of fluoride varnish |
186 |
183 |
$5K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
69 |
68 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
92 |
89 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
246 |
92 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
53 |
44 |
$1K |
| D0330 |
Panoramic radiographic image |
12 |
12 |
$504.96 |