| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
4,986 |
3,553 |
$118K |
| D1351 |
Sealant - per tooth |
6,575 |
1,099 |
$108K |
| D1120 |
Prophylaxis - child |
5,044 |
3,662 |
$92K |
| D1206 |
Topical application of fluoride varnish |
3,512 |
2,952 |
$63K |
| D0330 |
Panoramic radiographic image |
1,353 |
974 |
$44K |
| D7140 |
Extraction, erupted tooth or exposed root |
664 |
261 |
$43K |
| D0140 |
Limited oral evaluation - problem focused |
1,108 |
883 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,971 |
1,410 |
$25K |
| D2140 |
|
416 |
226 |
$21K |
| D0220 |
Intraoral - periapical first radiographic image |
2,366 |
1,684 |
$19K |
| D0230 |
Intraoral - periapical each additional radiographic image |
2,256 |
1,554 |
$16K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,340 |
1,128 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
926 |
566 |
$11K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
73 |
25 |
$9K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
282 |
234 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
25 |
13 |
$2K |
| D1110 |
Prophylaxis - adult |
123 |
55 |
$2K |