| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,943 |
1,933 |
$81K |
| D1120 |
Prophylaxis - child |
2,115 |
1,994 |
$59K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
448 |
291 |
$49K |
| D1351 |
Sealant - per tooth |
1,563 |
404 |
$44K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
505 |
330 |
$42K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
191 |
131 |
$26K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,366 |
1,230 |
$20K |
| D0272 |
Bitewings - two radiographic images |
1,037 |
972 |
$18K |
| D1206 |
Topical application of fluoride varnish |
575 |
572 |
$14K |
| D0330 |
Panoramic radiographic image |
427 |
427 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
190 |
190 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
985 |
975 |
$12K |
| D0274 |
Bitewings - four radiographic images |
438 |
434 |
$11K |
| D0230 |
Intraoral - periapical each additional radiographic image |
797 |
791 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
180 |
179 |
$7K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
223 |
211 |
$7K |
| D7140 |
Extraction, erupted tooth or exposed root |
44 |
39 |
$4K |
| D0120 |
Periodic oral evaluation - established patient |
229 |
89 |
$2K |