| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
2,318 |
2,242 |
$64K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
687 |
359 |
$60K |
| D1120 |
Prophylaxis - child |
1,555 |
1,504 |
$54K |
| D1110 |
Prophylaxis - adult |
810 |
781 |
$42K |
| D0145 |
Oral evaluation for a patient under three years of age |
301 |
281 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,333 |
2,255 |
$33K |
| D0272 |
Bitewings - two radiographic images |
1,399 |
1,357 |
$31K |
| D0274 |
Bitewings - four radiographic images |
844 |
814 |
$28K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
194 |
40 |
$26K |
| D0330 |
Panoramic radiographic image |
494 |
470 |
$20K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
507 |
480 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
331 |
319 |
$11K |
| D1206 |
Topical application of fluoride varnish |
250 |
241 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
296 |
290 |
$3K |
| D7140 |
Extraction, erupted tooth or exposed root |
41 |
32 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
112 |
$2K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
15 |
12 |
$1K |
| D0602 |
|
870 |
843 |
$0.00 |
| D0603 |
|
2,105 |
2,031 |
$0.00 |