| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
357 |
339 |
$15K |
| D1120 |
Prophylaxis - child |
523 |
507 |
$14K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
88 |
36 |
$8K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
58 |
13 |
$8K |
| D1206 |
Topical application of fluoride varnish |
498 |
481 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
126 |
38 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
153 |
129 |
$7K |
| D0240 |
|
414 |
209 |
$6K |
| D0120 |
Periodic oral evaluation - established patient |
240 |
229 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
75 |
74 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
172 |
166 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
106 |
86 |
$3K |
| D0272 |
Bitewings - two radiographic images |
122 |
118 |
$2K |