| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,784 |
1,741 |
$60K |
| D1120 |
Prophylaxis - child |
2,580 |
2,051 |
$47K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
512 |
258 |
$37K |
| D1206 |
Topical application of fluoride varnish |
1,524 |
1,284 |
$27K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
293 |
161 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
529 |
471 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
154 |
93 |
$15K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
93 |
49 |
$13K |
| D1351 |
Sealant - per tooth |
756 |
196 |
$11K |
| D0272 |
Bitewings - two radiographic images |
814 |
624 |
$9K |
| D0274 |
Bitewings - four radiographic images |
572 |
448 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
323 |
266 |
$9K |
| D0330 |
Panoramic radiographic image |
371 |
307 |
$8K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,153 |
773 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
86 |
55 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
226 |
210 |
$6K |
| D0210 |
Intraoral - complete series of radiographic images |
75 |
75 |
$5K |
| D0220 |
Intraoral - periapical first radiographic image |
403 |
341 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
189 |
126 |
$2K |
| D0120 |
Periodic oral evaluation - established patient |
645 |
98 |
$0.00 |