| Code | Description | Claims | Beneficiaries | Total Paid |
|---|
| D2930 |
Prefabricated stainless steel crown - primary tooth |
1,574 |
847 |
$174K |
| D1120 |
Prophylaxis - child |
4,102 |
3,910 |
$115K |
| D1206 |
Topical application of fluoride varnish |
4,273 |
4,123 |
$103K |
| D1999 |
|
5,836 |
4,913 |
$103K |
| D2392 |
Resin-based composite - two surfaces, posterior, primary or permanent |
1,110 |
691 |
$85K |
| D2391 |
Resin-based composite - one surface, posterior, primary or permanent |
1,195 |
711 |
$74K |
| D0120 |
Periodic oral evaluation - established patient |
3,263 |
3,130 |
$65K |
| D9230 |
Inhalation of nitrous oxide / analgesia, anxiolysis |
2,314 |
1,986 |
$48K |
| D0272 |
Bitewings - two radiographic images |
3,052 |
2,890 |
$46K |
| D7140 |
Extraction, erupted tooth or exposed root |
790 |
481 |
$44K |
| D0330 |
Panoramic radiographic image |
1,164 |
1,079 |
$39K |
| D1354 |
|
1,815 |
664 |
$36K |
| D0150 |
Comprehensive oral evaluation - new or established patient |
1,560 |
1,472 |
$36K |
| D1351 |
Sealant - per tooth |
1,463 |
476 |
$30K |
| D1110 |
Prophylaxis - adult |
428 |
407 |
$15K |
| D1208 |
Topical application of fluoride, excluding varnish |
996 |
975 |
$14K |
| D0140 |
Limited oral evaluation - problem focused |
449 |
416 |
$12K |
| D0220 |
Intraoral - periapical first radiographic image |
961 |
860 |
$10K |
| D0274 |
Bitewings - four radiographic images |
328 |
311 |
$6K |
| D2330 |
|
94 |
68 |
$5K |
| D0145 |
Oral evaluation for a patient under three years of age |
229 |
218 |
$5K |
| D1510 |
|
12 |
12 |
$2K |
| D0230 |
Intraoral - periapical each additional radiographic image |
100 |
37 |
$829.50 |
| D0240 |
|
16 |
16 |
$308.00 |
| D1310 |
|
362 |
330 |
$0.00 |
| D1330 |
|
360 |
328 |
$0.00 |