| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,695 |
2,573 |
$73K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,806 |
571 |
$66K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,533 |
713 |
$64K |
| D1120 |
Prophylaxis - child |
1,230 |
1,162 |
$50K |
| D0330 |
Panoramic radiographic image |
1,343 |
1,276 |
$47K |
| D1110 |
Prophylaxis - adult |
1,076 |
1,037 |
$40K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
673 |
429 |
$35K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,578 |
1,500 |
$23K |
| D2330 |
|
375 |
203 |
$16K |
| D0274 |
Bitewings - four radiographic images |
316 |
306 |
$7K |
| D0272 |
Bitewings - two radiographic images |
402 |
376 |
$6K |
| D0220 |
Intraoral - periapical first radiographic image |
424 |
398 |
$3K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
30 |
15 |
$3K |
| D9420 |
|
41 |
36 |
$2K |
| D7250 |
|
20 |
12 |
$1K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
34 |
27 |
$1K |