| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,940 |
1,932 |
$81K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
552 |
413 |
$62K |
| D1120 |
Prophylaxis - child |
2,189 |
2,061 |
$61K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
632 |
458 |
$54K |
| D1351 |
Sealant - per tooth |
1,528 |
452 |
$41K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
853 |
793 |
$28K |
| D1206 |
Topical application of fluoride varnish |
1,005 |
999 |
$24K |
| D2930 |
Prefabricated stainless steel crown - primary tooth |
149 |
100 |
$20K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,162 |
1,046 |
$17K |
| D0272 |
Bitewings - two radiographic images |
900 |
894 |
$16K |
| D0330 |
Panoramic radiographic image |
418 |
416 |
$13K |
| D0274 |
Bitewings - four radiographic images |
511 |
509 |
$13K |
| D0210 |
Intraoral - complete series of radiographic images |
188 |
188 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
981 |
969 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
770 |
729 |
$8K |
| D7140 |
Extraction, erupted tooth or exposed root |
45 |
32 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
83 |
80 |
$3K |
| D0120 |
Periodic oral evaluation - established patient |
274 |
139 |
$3K |