| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
430 |
133 |
$46K |
| D1120 |
Prophylaxis - child |
1,915 |
1,787 |
$41K |
| D1206 |
Topical application of fluoride varnish |
1,810 |
1,683 |
$39K |
| D0120 |
Periodic oral evaluation - established patient |
1,177 |
1,094 |
$33K |
| D9999 |
Unspecified adjunctive procedure, by report |
960 |
886 |
$21K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
242 |
89 |
$16K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
238 |
220 |
$8K |
| D0140 |
Limited oral evaluation - problem focused |
359 |
311 |
$6K |
| D7140 |
Extraction, erupted tooth or exposed root |
106 |
41 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
592 |
547 |
$4K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
169 |
125 |
$3K |
| D1999 |
|
205 |
174 |
$3K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
45 |
26 |
$2K |
| D1351 |
Sealant - per tooth |
109 |
33 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
702 |
292 |
$2K |
| D0272 |
Bitewings - two radiographic images |
142 |
126 |
$1K |