| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,475 |
1,409 |
$56K |
| D1120 |
Prophylaxis - child |
1,351 |
1,268 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
254 |
143 |
$25K |
| D1206 |
Topical application of fluoride varnish |
927 |
864 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
220 |
137 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
184 |
100 |
$15K |
| D0330 |
Panoramic radiographic image |
248 |
233 |
$10K |
| D0272 |
Bitewings - two radiographic images |
595 |
564 |
$10K |
| D0274 |
Bitewings - four radiographic images |
268 |
267 |
$6K |
| D1208 |
Topical application of fluoride, excluding varnish |
572 |
569 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
159 |
142 |
$6K |
| D1110 |
Prophylaxis - adult |
144 |
143 |
$1K |
| D0120 |
Periodic oral evaluation - established patient |
48 |
40 |
$970.98 |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
167 |
134 |
$290.88 |