| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
5,332 |
1,572 |
$731K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
5,561 |
3,555 |
$569K |
| D0120 |
Periodic oral evaluation - established patient |
21,010 |
20,649 |
$533K |
| D1120 |
Prophylaxis - child |
17,119 |
16,867 |
$460K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
9,918 |
9,445 |
$435K |
| D1208 |
Topical application of fluoride, excluding varnish |
20,092 |
19,765 |
$329K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
4,003 |
2,576 |
$309K |
| D7140 |
Extraction, erupted tooth or exposed root |
4,443 |
2,129 |
$274K |
| D0230 |
Intraoral - periapical each additional radiographic image |
18,168 |
6,242 |
$210K |
| D1351 |
Sealant - per tooth |
6,192 |
1,924 |
$174K |
| D1110 |
Prophylaxis - adult |
4,572 |
4,505 |
$168K |
| D0220 |
Intraoral - periapical first radiographic image |
8,482 |
8,257 |
$125K |
| D0330 |
Panoramic radiographic image |
2,244 |
2,193 |
$125K |
| D0140 |
Limited oral evaluation - problem focused |
2,514 |
2,407 |
$92K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
2,001 |
1,960 |
$88K |
| D0272 |
Bitewings - two radiographic images |
4,635 |
4,548 |
$84K |
| D9420 |
|
622 |
610 |
$71K |
| D2934 |
|
347 |
99 |
$63K |
| D0274 |
Bitewings - four radiographic images |
1,662 |
1,633 |
$51K |
| D1206 |
Topical application of fluoride varnish |
2,925 |
2,893 |
$46K |
| D0240 |
|
2,848 |
1,633 |
$45K |
| D1515 |
|
170 |
143 |
$40K |
| D1510 |
|
193 |
150 |
$34K |
| D3230 |
|
261 |
74 |
$34K |
| D1516 |
|
60 |
59 |
$16K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
135 |
114 |
$16K |
| D2330 |
|
214 |
126 |
$12K |
| D1517 |
|
26 |
25 |
$7K |
| D0145 |
Oral evaluation for a patient under three years of age |
80 |
80 |
$3K |
| D2332 |
|
12 |
12 |
$1K |
| D1354 |
|
102 |
39 |
$691.76 |