| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0140 |
Limited oral evaluation - problem focused |
653 |
518 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
225 |
84 |
$17K |
| D1208 |
Topical application of fluoride, excluding varnish |
562 |
554 |
$11K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
210 |
207 |
$7K |
| D1110 |
Prophylaxis - adult |
126 |
126 |
$7K |
| D1120 |
Prophylaxis - child |
166 |
165 |
$7K |
| D0330 |
Panoramic radiographic image |
74 |
74 |
$5K |
| D0274 |
Bitewings - four radiographic images |
80 |
79 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
98 |
98 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
125 |
124 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
27 |
12 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
42 |
41 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
42 |
26 |
$440.00 |