| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
279 |
53 |
$29K |
| D1120 |
Prophylaxis - child |
1,029 |
825 |
$29K |
| D0145 |
Oral evaluation for a patient under three years of age |
233 |
198 |
$26K |
| D0120 |
Periodic oral evaluation - established patient |
1,069 |
854 |
$24K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,145 |
916 |
$13K |
| D0272 |
Bitewings - two radiographic images |
652 |
527 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
214 |
180 |
$6K |
| D1110 |
Prophylaxis - adult |
110 |
88 |
$5K |
| D0274 |
Bitewings - four radiographic images |
111 |
83 |
$3K |
| D0220 |
Intraoral - periapical first radiographic image |
270 |
221 |
$3K |
| D0330 |
Panoramic radiographic image |
53 |
44 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
230 |
195 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
28 |
14 |
$325.32 |
| D0140 |
Limited oral evaluation - problem focused |
21 |
12 |
$225.36 |
| D0601 |
|
878 |
708 |
$0.00 |
| D0603 |
|
178 |
148 |
$0.00 |
| D0602 |
|
486 |
389 |
$0.00 |