| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
2,285 |
879 |
$288K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
3,705 |
1,601 |
$242K |
| D1120 |
Prophylaxis - child |
6,372 |
6,064 |
$162K |
| D0120 |
Periodic oral evaluation - established patient |
7,467 |
7,099 |
$141K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,469 |
2,309 |
$119K |
| D1206 |
Topical application of fluoride varnish |
7,758 |
7,387 |
$118K |
| D1351 |
Sealant - per tooth |
5,393 |
1,893 |
$111K |
| D9248 |
|
946 |
901 |
$109K |
| D0210 |
Intraoral - complete series of radiographic images |
1,517 |
1,455 |
$89K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,550 |
871 |
$79K |
| D7140 |
Extraction, erupted tooth or exposed root |
1,316 |
731 |
$66K |
| D1110 |
Prophylaxis - adult |
1,409 |
1,348 |
$51K |
| D0272 |
Bitewings - two radiographic images |
3,014 |
2,893 |
$46K |
| D0140 |
Limited oral evaluation - problem focused |
1,341 |
1,290 |
$31K |
| D9420 |
|
104 |
101 |
$23K |
| D0274 |
Bitewings - four radiographic images |
998 |
948 |
$22K |
| D0240 |
|
1,761 |
1,034 |
$22K |
| D0220 |
Intraoral - periapical first radiographic image |
1,408 |
1,345 |
$13K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
306 |
301 |
$6K |
| D1354 |
|
852 |
184 |
$6K |
| D0330 |
Panoramic radiographic image |
124 |
111 |
$6K |
| D2393 |
Resin-based composite - three surfaces, posterior, primary or permanent |
57 |
39 |
$5K |
| D0230 |
Intraoral - periapical each additional radiographic image |
569 |
263 |
$3K |
| D2332 |
|
22 |
13 |
$2K |
| D2330 |
|
21 |
12 |
$1K |