| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0210 |
Intraoral - complete series of radiographic images |
2,569 |
2,158 |
$132K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
3,184 |
2,692 |
$128K |
| D1120 |
Prophylaxis - child |
2,980 |
2,871 |
$113K |
| D1110 |
Prophylaxis - adult |
2,155 |
1,865 |
$94K |
| D0120 |
Periodic oral evaluation - established patient |
2,407 |
2,256 |
$69K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
977 |
392 |
$61K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
284 |
102 |
$52K |
| D1206 |
Topical application of fluoride varnish |
1,927 |
1,861 |
$51K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
626 |
268 |
$50K |
| D1351 |
Sealant - per tooth |
1,364 |
420 |
$45K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,531 |
1,463 |
$32K |
| D0330 |
Panoramic radiographic image |
451 |
430 |
$23K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
547 |
477 |
$21K |
| D0145 |
Oral evaluation for a patient under three years of age |
347 |
328 |
$18K |
| D0272 |
Bitewings - two radiographic images |
628 |
624 |
$15K |
| D0220 |
Intraoral - periapical first radiographic image |
852 |
805 |
$12K |
| D9920 |
|
128 |
64 |
$2K |
| D7140 |
Extraction, erupted tooth or exposed root |
18 |
12 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
192 |
85 |
$1K |
| D0274 |
Bitewings - four radiographic images |
44 |
43 |
$979.70 |
| D0140 |
Limited oral evaluation - problem focused |
35 |
34 |
$821.85 |