| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,290 |
1,935 |
$75K |
| D1120 |
Prophylaxis - child |
2,669 |
2,176 |
$59K |
| D1206 |
Topical application of fluoride varnish |
1,873 |
1,747 |
$39K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
183 |
42 |
$23K |
| D0272 |
Bitewings - two radiographic images |
690 |
648 |
$12K |
| D2140 |
|
138 |
86 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
120 |
55 |
$9K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
96 |
65 |
$9K |
| D0330 |
Panoramic radiographic image |
196 |
196 |
$8K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
356 |
292 |
$7K |
| D0274 |
Bitewings - four radiographic images |
137 |
136 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
106 |
102 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
219 |
204 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
71 |
69 |
$3K |
| D1208 |
Topical application of fluoride, excluding varnish |
204 |
82 |
$1K |
| D0210 |
Intraoral - complete series of radiographic images |
12 |
12 |
$795.84 |