| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,833 |
704 |
$327K |
| D1120 |
Prophylaxis - child |
5,014 |
4,841 |
$105K |
| D1206 |
Topical application of fluoride varnish |
4,867 |
4,676 |
$75K |
| D7140 |
Extraction, erupted tooth or exposed root |
889 |
375 |
$56K |
| D0120 |
Periodic oral evaluation - established patient |
4,088 |
3,967 |
$55K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,420 |
1,252 |
$30K |
| D0140 |
Limited oral evaluation - problem focused |
1,032 |
943 |
$29K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
995 |
954 |
$23K |
| D0272 |
Bitewings - two radiographic images |
1,366 |
1,305 |
$20K |
| D1110 |
Prophylaxis - adult |
663 |
639 |
$18K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
418 |
261 |
$16K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
258 |
158 |
$16K |
| D1510 |
|
119 |
70 |
$13K |
| D1351 |
Sealant - per tooth |
489 |
144 |
$10K |
| D0330 |
Panoramic radiographic image |
351 |
346 |
$9K |
| D1354 |
|
65 |
26 |
$6K |
| D0240 |
|
231 |
161 |
$4K |
| D0220 |
Intraoral - periapical first radiographic image |
281 |
256 |
$2K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,000 |
987 |
$2K |
| D0145 |
Oral evaluation for a patient under three years of age |
118 |
117 |
$1K |
| D0274 |
Bitewings - four radiographic images |
53 |
53 |
$143.00 |
| D1999 |
|
222 |
214 |
$10.00 |