| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
826 |
438 |
$85K |
| D1120 |
Prophylaxis - child |
3,711 |
3,485 |
$78K |
| D1206 |
Topical application of fluoride varnish |
5,110 |
4,812 |
$73K |
| D0120 |
Periodic oral evaluation - established patient |
4,815 |
4,540 |
$70K |
| D1110 |
Prophylaxis - adult |
1,798 |
1,696 |
$54K |
| D7140 |
Extraction, erupted tooth or exposed root |
925 |
444 |
$45K |
| D2150 |
Silver amalgam - two surfaces, primary or permanent |
1,072 |
660 |
$40K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,248 |
1,899 |
$39K |
| D0272 |
Bitewings - two radiographic images |
1,786 |
1,666 |
$29K |
| D2140 |
|
756 |
518 |
$25K |
| D0330 |
Panoramic radiographic image |
718 |
683 |
$23K |
| D1354 |
|
392 |
113 |
$19K |
| D1351 |
Sealant - per tooth |
1,218 |
239 |
$18K |
| D0274 |
Bitewings - four radiographic images |
638 |
604 |
$13K |
| D0140 |
Limited oral evaluation - problem focused |
612 |
575 |
$12K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
458 |
431 |
$11K |
| D7111 |
|
93 |
55 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
35 |
30 |
$2K |
| D9920 |
|
121 |
92 |
$2K |
| D2330 |
|
18 |
12 |
$1K |
| D9248 |
|
40 |
37 |
$577.50 |
| D2160 |
|
14 |
12 |
$376.12 |
| D1208 |
Topical application of fluoride, excluding varnish |
54 |
53 |
$111.25 |