| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
387 |
217 |
$49K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
448 |
276 |
$38K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
878 |
843 |
$38K |
| D1120 |
Prophylaxis - child |
1,068 |
1,046 |
$29K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
607 |
570 |
$25K |
| D1206 |
Topical application of fluoride varnish |
1,176 |
1,146 |
$18K |
| D7140 |
Extraction, erupted tooth or exposed root |
275 |
167 |
$17K |
| D0330 |
Panoramic radiographic image |
277 |
263 |
$15K |
| D0230 |
Intraoral - periapical each additional radiographic image |
1,034 |
569 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
690 |
665 |
$10K |
| D0120 |
Periodic oral evaluation - established patient |
335 |
330 |
$9K |
| D0140 |
Limited oral evaluation - problem focused |
190 |
183 |
$7K |
| D0272 |
Bitewings - two radiographic images |
364 |
352 |
$6K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
74 |
56 |
$6K |
| D1351 |
Sealant - per tooth |
90 |
39 |
$3K |
| D2330 |
|
21 |
12 |
$1K |
| D1110 |
Prophylaxis - adult |
36 |
36 |
$1K |