| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,511 |
755 |
$211K |
| D1120 |
Prophylaxis - child |
6,192 |
5,853 |
$207K |
| D1351 |
Sealant - per tooth |
7,323 |
1,360 |
$195K |
| D0120 |
Periodic oral evaluation - established patient |
7,386 |
6,929 |
$161K |
| D1206 |
Topical application of fluoride varnish |
6,588 |
6,329 |
$142K |
| D1110 |
Prophylaxis - adult |
2,437 |
2,249 |
$104K |
| D0272 |
Bitewings - two radiographic images |
3,583 |
3,347 |
$78K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,548 |
2,082 |
$71K |
| D0330 |
Panoramic radiographic image |
1,131 |
1,046 |
$59K |
| D7140 |
Extraction, erupted tooth or exposed root |
553 |
325 |
$46K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,022 |
955 |
$35K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
727 |
494 |
$34K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
545 |
366 |
$32K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,889 |
1,623 |
$32K |
| D1354 |
|
381 |
108 |
$19K |
| D0140 |
Limited oral evaluation - problem focused |
494 |
447 |
$14K |
| D9920 |
|
310 |
278 |
$12K |
| D0274 |
Bitewings - four radiographic images |
363 |
343 |
$11K |
| D0220 |
Intraoral - periapical first radiographic image |
860 |
754 |
$9K |
| D0240 |
|
330 |
259 |
$6K |
| D0145 |
Oral evaluation for a patient under three years of age |
91 |
90 |
$3K |
| D0210 |
Intraoral - complete series of radiographic images |
32 |
27 |
$931.36 |