| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,836 |
1,235 |
$410K |
| D1120 |
Prophylaxis - child |
9,080 |
8,975 |
$315K |
| D0120 |
Periodic oral evaluation - established patient |
9,176 |
9,074 |
$283K |
| D1206 |
Topical application of fluoride varnish |
8,970 |
8,865 |
$261K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,469 |
729 |
$120K |
| D0272 |
Bitewings - two radiographic images |
4,351 |
4,289 |
$99K |
| D0330 |
Panoramic radiographic image |
1,479 |
1,459 |
$91K |
| D0145 |
Oral evaluation for a patient under three years of age |
1,468 |
1,451 |
$64K |
| D0140 |
Limited oral evaluation - problem focused |
1,384 |
1,339 |
$63K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,639 |
1,594 |
$58K |
| D1208 |
Topical application of fluoride, excluding varnish |
2,369 |
2,347 |
$49K |
| D9420 |
|
144 |
136 |
$33K |
| D0274 |
Bitewings - four radiographic images |
865 |
861 |
$30K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
600 |
594 |
$29K |
| D0220 |
Intraoral - periapical first radiographic image |
1,384 |
1,295 |
$18K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,819 |
765 |
$17K |
| D0350 |
|
134 |
133 |
$4K |
| D9310 |
|
79 |
79 |
$4K |
| D1110 |
Prophylaxis - adult |
86 |
85 |
$3K |
| D7962 |
|
12 |
12 |
$2K |
| D3120 |
|
12 |
12 |
$0.00 |
| D1354 |
|
867 |
400 |
$0.00 |