| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,869 |
1,765 |
$65K |
| D1120 |
Prophylaxis - child |
1,693 |
1,594 |
$47K |
| D0330 |
Panoramic radiographic image |
737 |
715 |
$37K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
363 |
190 |
$36K |
| D0274 |
Bitewings - four radiographic images |
1,330 |
1,247 |
$29K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,765 |
1,664 |
$28K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
735 |
595 |
$24K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
232 |
121 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
189 |
112 |
$16K |
| D1351 |
Sealant - per tooth |
476 |
127 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
178 |
173 |
$7K |
| D0120 |
Periodic oral evaluation - established patient |
162 |
157 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
14 |
13 |
$172.38 |