| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0120 |
Periodic oral evaluation - established patient |
1,743 |
1,686 |
$43K |
| D1120 |
Prophylaxis - child |
1,819 |
1,769 |
$39K |
| D1206 |
Topical application of fluoride varnish |
2,346 |
2,276 |
$33K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
313 |
185 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
563 |
551 |
$23K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
393 |
276 |
$21K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,458 |
709 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
715 |
627 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
202 |
155 |
$14K |
| D0240 |
|
786 |
568 |
$12K |
| D0272 |
Bitewings - two radiographic images |
745 |
737 |
$11K |
| D0274 |
Bitewings - four radiographic images |
457 |
451 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
947 |
894 |
$9K |
| D7140 |
Extraction, erupted tooth or exposed root |
176 |
93 |
$9K |
| D1351 |
Sealant - per tooth |
363 |
128 |
$7K |
| D1110 |
Prophylaxis - adult |
231 |
229 |
$7K |
| D0210 |
Intraoral - complete series of radiographic images |
165 |
165 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
93 |
91 |
$3K |
| D0140 |
Limited oral evaluation - problem focused |
57 |
56 |
$1K |
| D0330 |
Panoramic radiographic image |
35 |
35 |
$1K |