| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
445 |
95 |
$69K |
| D1120 |
Prophylaxis - child |
638 |
631 |
$21K |
| D1206 |
Topical application of fluoride varnish |
591 |
586 |
$15K |
| D0120 |
Periodic oral evaluation - established patient |
432 |
425 |
$12K |
| D1351 |
Sealant - per tooth |
240 |
45 |
$8K |
| D0272 |
Bitewings - two radiographic images |
273 |
268 |
$5K |
| D7140 |
Extraction, erupted tooth or exposed root |
49 |
26 |
$4K |
| D0145 |
Oral evaluation for a patient under three years of age |
82 |
81 |
$4K |
| D0140 |
Limited oral evaluation - problem focused |
115 |
113 |
$3K |
| D0240 |
|
459 |
165 |
$3K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
80 |
79 |
$2K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
57 |
56 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
346 |
90 |
$2K |
| D9420 |
|
16 |
15 |
$2K |
| D0330 |
Panoramic radiographic image |
29 |
29 |
$1K |
| D0220 |
Intraoral - periapical first radiographic image |
130 |
127 |
$1K |