| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
541 |
217 |
$73K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,642 |
1,421 |
$66K |
| D1120 |
Prophylaxis - child |
2,147 |
1,914 |
$53K |
| D1206 |
Topical application of fluoride varnish |
2,122 |
1,893 |
$31K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
584 |
478 |
$24K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
231 |
101 |
$21K |
| D0330 |
Panoramic radiographic image |
351 |
308 |
$17K |
| D0120 |
Periodic oral evaluation - established patient |
597 |
590 |
$16K |
| D0272 |
Bitewings - two radiographic images |
814 |
709 |
$13K |
| D1351 |
Sealant - per tooth |
545 |
118 |
$13K |
| D7140 |
Extraction, erupted tooth or exposed root |
195 |
118 |
$13K |
| D0220 |
Intraoral - periapical first radiographic image |
887 |
793 |
$12K |
| D0230 |
Intraoral - periapical each additional radiographic image |
910 |
389 |
$10K |
| D0240 |
|
540 |
295 |
$7K |
| D2335 |
|
49 |
16 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
73 |
47 |
$6K |
| D0140 |
Limited oral evaluation - problem focused |
100 |
99 |
$4K |
| D1110 |
Prophylaxis - adult |
13 |
12 |
$477.96 |
| D1354 |
|
69 |
24 |
$434.50 |
| D0145 |
Oral evaluation for a patient under three years of age |
24 |
16 |
$38.01 |