| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,632 |
5,027 |
$174K |
| D1120 |
Prophylaxis - child |
6,915 |
4,688 |
$121K |
| D1206 |
Topical application of fluoride varnish |
2,970 |
2,702 |
$63K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
412 |
79 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
330 |
198 |
$31K |
| D0272 |
Bitewings - two radiographic images |
2,148 |
1,602 |
$30K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
974 |
866 |
$27K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,890 |
1,441 |
$19K |
| D7140 |
Extraction, erupted tooth or exposed root |
233 |
123 |
$18K |
| D0120 |
Periodic oral evaluation - established patient |
656 |
517 |
$13K |
| D0274 |
Bitewings - four radiographic images |
423 |
378 |
$11K |
| D0330 |
Panoramic radiographic image |
238 |
232 |
$11K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
57 |
42 |
$5K |
| D0140 |
Limited oral evaluation - problem focused |
114 |
107 |
$4K |
| D9248 |
|
36 |
33 |
$2K |
| D1351 |
Sealant - per tooth |
44 |
15 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
58 |
53 |
$689.80 |
| D0240 |
|
28 |
26 |
$0.00 |