| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,534 |
2,426 |
$96K |
| D1120 |
Prophylaxis - child |
4,193 |
3,432 |
$88K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
606 |
366 |
$64K |
| D1206 |
Topical application of fluoride varnish |
2,756 |
2,596 |
$58K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
754 |
724 |
$25K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
299 |
208 |
$24K |
| D0272 |
Bitewings - two radiographic images |
1,526 |
1,378 |
$24K |
| D0330 |
Panoramic radiographic image |
601 |
549 |
$23K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
123 |
57 |
$16K |
| D0274 |
Bitewings - four radiographic images |
708 |
648 |
$16K |
| D7140 |
Extraction, erupted tooth or exposed root |
173 |
100 |
$13K |
| D0120 |
Periodic oral evaluation - established patient |
1,179 |
612 |
$13K |
| D1208 |
Topical application of fluoride, excluding varnish |
937 |
692 |
$10K |
| D0140 |
Limited oral evaluation - problem focused |
241 |
235 |
$9K |
| D0220 |
Intraoral - periapical first radiographic image |
765 |
744 |
$9K |
| D0145 |
Oral evaluation for a patient under three years of age |
251 |
245 |
$8K |
| D0210 |
Intraoral - complete series of radiographic images |
56 |
56 |
$4K |
| D0230 |
Intraoral - periapical each additional radiographic image |
354 |
281 |
$4K |
| D1351 |
Sealant - per tooth |
131 |
26 |
$4K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
15 |
13 |
$2K |
| D9248 |
|
37 |
36 |
$2K |
| D0603 |
|
718 |
606 |
$0.00 |