| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
7,074 |
5,963 |
$223K |
| D1120 |
Prophylaxis - child |
6,945 |
5,832 |
$162K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
974 |
642 |
$105K |
| D1206 |
Topical application of fluoride varnish |
3,920 |
3,637 |
$89K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
324 |
78 |
$45K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,644 |
1,479 |
$43K |
| D0272 |
Bitewings - two radiographic images |
2,352 |
2,119 |
$42K |
| D7140 |
Extraction, erupted tooth or exposed root |
502 |
276 |
$40K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,327 |
1,837 |
$28K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
255 |
197 |
$21K |
| D0330 |
Panoramic radiographic image |
428 |
407 |
$19K |
| D0120 |
Periodic oral evaluation - established patient |
550 |
442 |
$12K |
| D0140 |
Limited oral evaluation - problem focused |
276 |
261 |
$11K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
97 |
42 |
$8K |
| D9248 |
|
212 |
199 |
$8K |
| D1351 |
Sealant - per tooth |
199 |
62 |
$5K |
| D0274 |
Bitewings - four radiographic images |
139 |
139 |
$4K |
| D0210 |
Intraoral - complete series of radiographic images |
66 |
66 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
222 |
192 |
$2K |
| D0240 |
|
16 |
13 |
$60.00 |