| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,530 |
305 |
$190K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,261 |
1,239 |
$167K |
| D1351 |
Sealant - per tooth |
4,645 |
821 |
$112K |
| D1120 |
Prophylaxis - child |
3,453 |
3,305 |
$112K |
| D0120 |
Periodic oral evaluation - established patient |
2,841 |
2,710 |
$74K |
| D0230 |
Intraoral - periapical each additional radiographic image |
7,864 |
2,845 |
$67K |
| D0220 |
Intraoral - periapical first radiographic image |
3,439 |
3,237 |
$35K |
| D0272 |
Bitewings - two radiographic images |
1,997 |
1,892 |
$34K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
995 |
942 |
$30K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,014 |
1,937 |
$27K |
| D1206 |
Topical application of fluoride varnish |
1,680 |
1,566 |
$21K |
| D7140 |
Extraction, erupted tooth or exposed root |
319 |
114 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
551 |
503 |
$13K |
| D1110 |
Prophylaxis - adult |
263 |
251 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
683 |
633 |
$11K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
127 |
67 |
$11K |
| D0330 |
Panoramic radiographic image |
215 |
210 |
$7K |
| D0274 |
Bitewings - four radiographic images |
204 |
187 |
$5K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
43 |
24 |
$3K |
| D0160 |
|
27 |
25 |
$327.41 |
| D0603 |
|
5,717 |
5,552 |
$0.00 |
| D1330 |
|
33 |
33 |
$0.00 |