| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,581 |
1,565 |
$62K |
| D1120 |
Prophylaxis - child |
2,372 |
2,151 |
$62K |
| D1206 |
Topical application of fluoride varnish |
1,436 |
1,372 |
$33K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
311 |
193 |
$32K |
| D0330 |
Panoramic radiographic image |
500 |
475 |
$26K |
| D0272 |
Bitewings - two radiographic images |
1,060 |
948 |
$19K |
| D1351 |
Sealant - per tooth |
744 |
181 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
211 |
132 |
$17K |
| D0274 |
Bitewings - four radiographic images |
584 |
542 |
$16K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
514 |
481 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
969 |
813 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
687 |
493 |
$12K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
91 |
69 |
$8K |
| D0145 |
Oral evaluation for a patient under three years of age |
113 |
113 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
187 |
180 |
$2K |
| D0140 |
Limited oral evaluation - problem focused |
46 |
42 |
$2K |
| D1110 |
Prophylaxis - adult |
13 |
13 |
$780.00 |