| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
886 |
823 |
$51K |
| D0330 |
Panoramic radiographic image |
574 |
537 |
$39K |
| D1206 |
Topical application of fluoride varnish |
870 |
824 |
$26K |
| D1120 |
Prophylaxis - child |
563 |
537 |
$24K |
| D7140 |
Extraction, erupted tooth or exposed root |
285 |
127 |
$21K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
395 |
326 |
$16K |
| D1110 |
Prophylaxis - adult |
290 |
250 |
$15K |
| D1351 |
Sealant - per tooth |
329 |
84 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
121 |
95 |
$11K |
| D0272 |
Bitewings - two radiographic images |
511 |
473 |
$10K |
| D0145 |
Oral evaluation for a patient under three years of age |
142 |
135 |
$8K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
55 |
41 |
$7K |
| D0220 |
Intraoral - periapical first radiographic image |
430 |
389 |
$7K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
28 |
12 |
$5K |
| D0120 |
Periodic oral evaluation - established patient |
111 |
99 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
236 |
208 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
193 |
141 |
$2K |
| D0210 |
Intraoral - complete series of radiographic images |
25 |
23 |
$1K |