| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,148 |
2,820 |
$116K |
| D1120 |
Prophylaxis - child |
3,028 |
2,795 |
$85K |
| D0210 |
Intraoral - complete series of radiographic images |
906 |
885 |
$62K |
| D1206 |
Topical application of fluoride varnish |
1,696 |
1,645 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
538 |
150 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,359 |
905 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,458 |
1,317 |
$23K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
218 |
109 |
$20K |
| D1351 |
Sealant - per tooth |
617 |
127 |
$16K |
| D0220 |
Intraoral - periapical first radiographic image |
1,144 |
1,006 |
$14K |
| D0272 |
Bitewings - two radiographic images |
601 |
576 |
$13K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,145 |
774 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
232 |
202 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
49 |
24 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
97 |
53 |
$6K |
| D1110 |
Prophylaxis - adult |
124 |
117 |
$6K |
| D0330 |
Panoramic radiographic image |
144 |
134 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
187 |
179 |
$5K |
| D0274 |
Bitewings - four radiographic images |
130 |
123 |
$4K |
| D0602 |
|
14 |
14 |
$65.00 |
| D0603 |
|
12 |
12 |
$60.00 |