| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,743 |
491 |
$144K |
| D7140 |
Extraction, erupted tooth or exposed root |
866 |
412 |
$42K |
| D1120 |
Prophylaxis - child |
2,150 |
2,105 |
$39K |
| D1354 |
|
3,227 |
736 |
$24K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,009 |
981 |
$21K |
| D0140 |
Limited oral evaluation - problem focused |
599 |
577 |
$17K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
910 |
860 |
$16K |
| D0240 |
|
1,483 |
840 |
$15K |
| D1206 |
Topical application of fluoride varnish |
1,920 |
1,880 |
$14K |
| D0120 |
Periodic oral evaluation - established patient |
1,113 |
1,093 |
$13K |
| D0272 |
Bitewings - two radiographic images |
1,003 |
975 |
$11K |
| D1351 |
Sealant - per tooth |
789 |
306 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
1,133 |
1,077 |
$9K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,534 |
614 |
$9K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
113 |
78 |
$6K |
| D0603 |
|
1,617 |
1,585 |
$5K |
| D3220 |
Therapeutic pulpotomy (excluding final restoration) - removal of pulp coronal to the dentinocemental junction |
85 |
57 |
$4K |
| D0330 |
Panoramic radiographic image |
119 |
115 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
51 |
44 |
$3K |
| D0145 |
Oral evaluation for a patient under three years of age |
127 |
125 |
$2K |
| D0602 |
|
350 |
343 |
$741.00 |
| D9920 |
|
636 |
618 |
$410.00 |
| D1330 |
|
1,337 |
1,304 |
$100.00 |
| D0601 |
|
14 |
14 |
$20.00 |
| D9986 |
|
466 |
435 |
$0.00 |
| D1999 |
|
13 |
13 |
$0.00 |
| D9994 |
|
134 |
131 |
$0.00 |
| D1310 |
|
130 |
127 |
$0.00 |