| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
392 |
381 |
$16K |
| D1120 |
Prophylaxis - child |
404 |
391 |
$12K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
68 |
47 |
$7K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
89 |
54 |
$7K |
| D1206 |
Topical application of fluoride varnish |
267 |
262 |
$6K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
127 |
122 |
$5K |
| D1351 |
Sealant - per tooth |
155 |
40 |
$4K |
| D0330 |
Panoramic radiographic image |
111 |
103 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
37 |
37 |
$2K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
18 |
13 |
$2K |
| D0272 |
Bitewings - two radiographic images |
161 |
157 |
$2K |
| D0274 |
Bitewings - four radiographic images |
90 |
88 |
$2K |
| D0220 |
Intraoral - periapical first radiographic image |
154 |
150 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
87 |
81 |
$1K |
| D0230 |
Intraoral - periapical each additional radiographic image |
134 |
130 |
$1K |
| D0140 |
Limited oral evaluation - problem focused |
30 |
29 |
$1K |
| D7140 |
Extraction, erupted tooth or exposed root |
13 |
12 |
$912.01 |