| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,077 |
230 |
$108K |
| D1120 |
Prophylaxis - child |
3,519 |
3,324 |
$94K |
| D1206 |
Topical application of fluoride varnish |
3,644 |
3,485 |
$83K |
| D1999 |
|
3,874 |
3,574 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
3,697 |
3,465 |
$68K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
694 |
387 |
$53K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
1,483 |
1,257 |
$30K |
| D0272 |
Bitewings - two radiographic images |
1,624 |
1,496 |
$26K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
927 |
908 |
$24K |
| D1110 |
Prophylaxis - adult |
652 |
619 |
$23K |
| D1208 |
Topical application of fluoride, excluding varnish |
1,402 |
1,270 |
$19K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
249 |
158 |
$17K |
| D7140 |
Extraction, erupted tooth or exposed root |
307 |
124 |
$16K |
| D0140 |
Limited oral evaluation - problem focused |
472 |
455 |
$14K |
| D0330 |
Panoramic radiographic image |
241 |
240 |
$11K |
| D1351 |
Sealant - per tooth |
460 |
160 |
$10K |
| D0220 |
Intraoral - periapical first radiographic image |
516 |
474 |
$5K |
| D0240 |
|
269 |
120 |
$4K |
| D0274 |
Bitewings - four radiographic images |
136 |
133 |
$3K |
| D0230 |
Intraoral - periapical each additional radiographic image |
32 |
12 |
$336.00 |
| D9420 |
|
25 |
13 |
$0.00 |