| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,311 |
2,252 |
$93K |
| D1120 |
Prophylaxis - child |
3,048 |
2,736 |
$79K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
487 |
356 |
$53K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
604 |
448 |
$51K |
| D1351 |
Sealant - per tooth |
1,846 |
582 |
$49K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
239 |
163 |
$32K |
| D1206 |
Topical application of fluoride varnish |
1,109 |
1,096 |
$25K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,624 |
1,497 |
$24K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
759 |
722 |
$23K |
| D0330 |
Panoramic radiographic image |
550 |
541 |
$21K |
| D0272 |
Bitewings - two radiographic images |
1,157 |
1,094 |
$19K |
| D0274 |
Bitewings - four radiographic images |
502 |
499 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
1,017 |
993 |
$12K |
| D0120 |
Periodic oral evaluation - established patient |
616 |
438 |
$11K |
| D0210 |
Intraoral - complete series of radiographic images |
151 |
151 |
$10K |
| D7140 |
Extraction, erupted tooth or exposed root |
108 |
77 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
795 |
753 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
122 |
120 |
$5K |